How to Determine If Your Workers’ Compensation Claim Was Wrongly Denied
A medical peer review is performed by a physician hired by a workers’ comp insurer to determine medical necessity. Here are some reasons for claim denial.
MOS Medical Record Reviews 8596 E. 101st Street, Suite H Tulsa, OK 74133
A medical peer review is performed by a physician hired by a workers’ compensation insurer, to determine whether the medical care sought by the injured employee is necessary or not. Peer review doctors are not required to examine the injured worker or ask them any questions regarding the job related injury. If a peer review physician finds the medical services unnecessary, the claim may be denied by the insurance company. That is when workers consider hiring an attorney to fight for their rights. The eligibility for workers’ compensation benefits depends on various factors such as workers’ comp laws in the employee’s state, whether or not he/she is employed by the federal government, the type of industry the employee works in, and so on. What are some of the common reasons for workers’ compensation claim denial? •
Missed report deadlines: If an injured employee waits past the official deadline to report their injury to the employer, he/she will be unable to file a claim. According to the law, you must notify your employer within 30 days of the accident in most states. Ensure to report any injuries to your superior immediately after the accident.
•
Treatment is not medically necessary: Sometimes the employer or insurer may determine that the injury did not require the medical treatment requested.
•
Claim processing mistake: It is possible that a mistake made when processing the claim can cause the claim to be denied. Those who process the claim may miss minor details and that could lead to claim denial.
•
Missed claim filing deadlines: Your claim must be filed before the deadline that may vary among the different states. If you don’t file the claim within 30 days, there is a high chance of it being denied.
Employers, in an effort to save costs and avoid responsibility, may request the employee not to file a claim or even say that the employee is not entitled to workers’ compensation. Injured workers should not fall for this because they will be losing the valuable compensation they so desperately need. Injured employees must seek medical treatment immediately after sustaining the injury. To receive workers’ compensation, they will have to submit to an IME (independent medical exam), and provide details regarding the injury and their condition to help determine whether the injury was a direct result of the nature of the work environment. It is vital that the injured worker receives the right analysis and not a biased one. As a medical review company assisting workers’ compensation lawyers, we understand that a wrongfully denied claim can be appealed. Appealing a denied claim can be rather challenging, and legal support is a great option in this regard. Workers’ compensation
www.mosmedicalrecordreview.com
918-221-7791
attorneys who are experienced in this field know exactly how to handle a claim that was denied wrongfully. Injured workers notified of the denial can petition to the workers’ compensation appeals board. The appeal process could vary according to individual cases, which makes legal assistance important because lawyers can provide the required guidance at each stage. They will also work to ensure that their clients receive the compensation due to them that would cover major expenses related to medical treatment and vocational rehabilitation services, as well as provide payment for time spent away from work or that for the loss of a loved one. Just because a claim is denied, injured employees should not assume that they will not get the benefits. A good workers’ compensation attorney can help in this regard with proper legal counsel.
www.mosmedicalrecordreview.com
918-221-7791