Requirements for Medical Treatment in Boston Workers’ Compensation

After a workplace accident, proper medical care can be crucial. Unfortunately, the insurance companies sometimes set strict requirements for medical treatment in Boston workers’ compensation cases. Injured workers’ may be unhappy with the insurer-recommend providers and feel pressured to return to work before they are ready.

Thankfully, the insurance company’s role in medical treatment is not absolute. A dedicated workers’ compensation attorney could help fight on behalf of injury victims. They could help you receive the care you need to fully recover from your injuries.

Insurance Company-Recommended Doctors

The workers’ compensation statute in Massachusetts allows employers and insurers to require the injured worker to see a preferred provider of the insurer one time. After that initial examination, the injured worker may choose their own doctor. The worker has the right to get a second opinion and may change doctors within the same specialty once. Depending on the circumstances of the case, the insurer might approve and pay for an additional evaluation and possibly a change of providers, even though the injured person previously obtained a second opinion. That is another reason why it is important to seek consultation with an experienced workers’ compensation lawyer to help access qualified medical providers who accept workers’ comp patients.

Frequently, workers do not know they can choose their own doctor. The insurance company often tries to send the injured worker to a doctor in a clinic that has a relationship with the workers’ compensation insurance company. An injured worker being treated by a preferred doctor may be at risk of being sent back to work while they are still injured, or in some cases, before their injury has been fully evaluated.

Those doctors tend to be conservative and biased against injured workers and might not acknowledge the injured worker’s reports of symptoms of pain. They might not thoroughly investigate the injury and might not send the injured worker for diagnostic testing such as CT-Scans and MRI’s. The doctor might assume that it is just a sprain/strain injury of the muscles when, actually, the injury may be much more serious.

Role of the Insurance Company

Insurance companies have a lot of control because the workers’ compensation system has the utilization review (UR) process. The UR process requires all medical providers to submit a request for approval of treatment, whether it is a consultation, physical therapy, diagnostic testing, or even surgery. However, the insurance company’s role in dictating medical treatment is not absolute.

Without representation by a workers’ compensation lawyer, an injured worker is at a disadvantage when trying to navigate the UR process. An insurance company may be non-responsive or take an unreasonable amount of time to respond to a request for treatment. When the insurance company does not respond, the medical provider’s office may become frustrated because the insurance adjuster has not responded to their request for UR approval. Medical providers do not keep submitting requests. As a result, the injured worker may be in limbo and not know what to do. If the injured worker is represented by a workers’ comp lawyer, he could file a claim with the DIA for medical treatment.

Discuss Your Medical Treatment with a Boston Workers’ Compensation Attorney

If you are unhappy with the insurance company’s requirements for medical treatment in Boston workers’ compensation cases, call a lawyer today. A veteran workers’ comp attorney could fight on your behalf for access to adequate care. They could handle negotiations on your behalf and make sure your rights are respected. Call today to schedule a consultation.