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Treatment: What if the insurance company just refuses to provide medical treatment?

When the workers' compensation insurance company refuses to provide treatment at all, or discontinues your medical treatment, it is usually because of one or more of the following:
  • Your case is being denied. Your case may be denied because the employer/insurer believes you did not sustain your injury at work, that the incident that caused your injury does not meet the definition of "accident," that you failed to provide the proper notice, etc.
  • The employer/insurer believes that your work-related injury or condition has reached "maximum medical improvement" (that you have recovered as much as possible and, therefore, no additional medical care is reasonably needed).
  • The employer/insurer believes that the condition for which you are being treated, or are seeking treatment, is the result of a preexisting condition, and not the result of the work accident.
  • The employer/insurer believes that you have been non-compliant with your medical treatment or have abandoned your medical treatment (for example, missed appointments).
If you are confused as to why your medical treatment has been refused or discontinued, ask the insurance company for an explanation in writing. Often, treatment is refused or discontinued because of miscommunication, delays in receiving information, or incorrect or incomplete information. These problems can usually be resolved by communicating with the insurance company. If that doesn't help, you can ask for a conference with an administrative law judge to discuss your concerns.

If you have filed a claim for compensation, you can ask that your case be scheduled for an evidentiary hearing (trial) to have the judge decide if the employer/insurer is required to provide you with medical treatment. The employee has the burden of proof on all issues, and medical evidence is required. For more information about these types of evidentiary hearings, read What to Expect If Your Case Goes to Trial.

If you believe the employer/insurer has refused or discontinued your medical treatment without legal cause, you may have the right to obtain medical treatment on your own, and when your case goes before the administrative law judge for an evidentiary hearing (trial), you can ask the judge to order the employer/insurer to pay the medical bills. For more information, read What to Expect If Your Case Goes to Trial.

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