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What to do when the workers' compensation insurer won't pay for medical treatment.

Posted by Robert Scott | Nov 10, 2021 | 0 Comments

Too often, the workers' compensation insurer refuses to authorize medical treatment of a work injury. Although there are certain situations where such a denial is supported by the law, a lot of the time the denial of medical treatment is unjustified. This is unfortunate because any denial of medical treatment delays the worker's recovery, delays the worker's return to work, and delays resolution of the worker's case. Worst case scenario, the denial of medical treatment makes the worker's injuries worse which usually makes additional medical treatment necessary.

An injured worker has the following limited options if the workers' compensation insurer denies medical treatment:

  • The worker can postpone getting the treatment to litigate the denied treatment. It can take months, sometimes a year or more, for a workers' compensation judge to decide if the denial of medical treatment was proper. Obviously, this is not optimal.
  • If the worker has access to other medical insurance (spousal coverage, Medicaid, Medicare, etc.), the worker can try to use that insurance to pay for the denied medical treatment. In my experience, as long as the workers' compensation insurer has refused to authorize the medical treatment the other medical insurer will pay for the treatment. The problem is that there are usually co-pays and other out of pocket costs that the injured worker has to pay. If the worker's case is successful, the workers' compensation insurer will usually have to repay the other medical insurer which can be a complicated process in itself.
  • The worker can forego the medical treatment which is usually not an option in most cases.

Getting medical treatment as quickly as possible is critical to getting an injured worker back to work as soon as possible. It is also critical for resolving the injured worker's case as quickly as possible. Therefore, when a workers' compensation insurer denies medical treatment and other medical insurance is available (and will pay for the treatment), I usually recommend to the client to use the other medical insurance to pay for the denied medical treatment.

About the Author

Robert Scott

“One of the most experienced workers' compensation attorneys in New Mexico.” After graduating from high school in New York, I attended the College of William & Mary on an ROTC scholarship and earned a degree in Spanish. I served four years in the United States Army as an infantry lieutenant.

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