What Are My Rights If an Insurance Company Is Wrongly Trying To Stop My Workers’ Comp Medical Treatments?

When an insurance company discontinues medical treatment, it is typically because of one of the following:

• An employer (and its insurer) believe that a work-related injury or illness has reached Maximum Medical Improvement (“MMI”), meaning an individual has allegedly recovered as much as possible and, therefore, medical care will no longer improve the condition.
• An employer believes an injury or condition is the result of a preexisting condition (and not the result of a work accident).
• An employer claims an employee has been non-compliant with or abandoned medical treatment.

Treatments are often refused or discontinued because of miscommunications, lack of documentation, or incorrect or incomplete information. Consequently, many issues can be resolved by working with an insurance adjuster or discussing concerns with an Administrative Law Judge.

If you believe that your medical treatments are being wrongly discontinued, we urge you to call The Law Offices of Mark T. Hurt to schedule a complimentary consultation with experienced workers’ compensation attorney Mark Hurt. We can listen to the facts of your case and explain your legal options for appealing unfavorable determinations.

What is Maximum Medical Improvement (MMI)?

Under Virginia’s workers’ compensation law, workers who are temporarily disabled are entitled to receive a portion of their wages until they are authorized to resume work or until they have reached MMI. MMI means that an individual’s condition is not expected to improve, rendering additional medical treatments ineffective for increased improvement.

Insurance carriers will be especially interested in trying to stop payments and medical treatment by claiming that MMI has been reached, and that the medical treatments being received by an injured worker will not lead to permanent benefits. As an experienced workers’ comp attorney, Mark Hurt can help you seek to have compensation and treatment continued for as long as required under the law.

How Much Does an Experienced Workers’ Compensation Lawyer Cost?

Before commencing representation, firm-founding attorney Mark Hurt will explain the fee structure (which must be approved by the Workers’ Compensation Commission) and answer any questions you may have.

What Types of Workers’ Compensation Medical Treatments Must Be Covered in Virginia?

The Virginia Workers’ Compensation Act requires employers (and their insurance companies) to pay for all medical treatments that are reasonable, necessary, and relate to a compensable workplace injury (regardless of who was to blame for the condition).

For example, an insurer could be responsible for the following types of expenses:

• ER Visits
• Hospital Visits
• Doctor’s Appointments
• Prescription Medication
• Physical Therapy
• Diagnostic Testing
• Surgery
• Pain Management
• Durable Medical Equipment

Can A Doctor Bill Me for The Balance Not Paid by Workers’ Compensation Insurance?

No. If an individual is injured on the job, an employers’ insurer is responsible for paying for any reasonable and necessary medical treatments. Consequently, injured workers should never be responsible for a co-payment, and medical providers are prohibited from billing patients for any balances not paid by the insurance company.

Unfortunately, despite this mandate, many injured workers still receive medical bills. If you or a loved one received a medical bill or was denied treatment, call our office immediately to learn about your legal options.

What Should I Do If Workers’ Compensation Insurance Denies Payment of Medical Treatment?

If a workers’ compensation insurance company denies medical treatment recommended by an authorized treating physician, several options exist for challenging the denial.

• Contact the Insurer. Many medical treatment denials can be resolved through a brief phone conversation. For example, an adjuster may need additional information from a physician’s office. In situations such as these, it is often advisable to contact an adjuster by email or phone to discuss the missing documentation to remedy the issue expeditiously.
• File a Change in Condition Claim. If an insurance adjuster refuses to respond to calls or emails (or refuses to pay for a claim), a change in condition claim can be filed, seeking authorization and payment from the Commission.
• Schedule an Administrative Hearing. If an insurer continues to deny valid medical care or fails to respond, the Commission will schedule a workers’ compensation hearing before an Administrative Law Judge. Much like a traditional court case, at a hearing, workers are entitled to present evidence in support of a claim, and a judge will determine whether the insurance company must pay for treatment.

Call Our Office to Schedule a Free Consultation with Experienced Workers’ Compensation Lawyer Mark Hurt.

Defending a medical treatment denial can be challenging, as most insurance companies will do everything possible to avoid paying for treatment. At The Law Offices of Mark T. Hurt, we work to resolve denials without litigation; however, if necessary, we will not hesitate to take a case to trial or negotiate a settlement (if appropriate). Call our office today to schedule a free consultation to get started.