I was told I have lifetime medical coverage, under workers’ compensation, but they are denying my claim!
The Law. Many injured workers remember that towards the end of their case, when they settled, received a lump sum award, or weekly payments for a set period of time for their workers’ compensation claim, they were told that there right to medical treatment was left open for the duration of their life. However, of course, this comes with a caveat; according to the Workers’ Compensation Law of Maryland, injured workers are entitled to medical treatment with no time limitation, unless stipulated otherwise, for the body part that was injured at the time of the accident as long as the requested medical treatment is reasonable and necessary and is casually related to the original accidental injury.
What does this really mean? For continued medical treatment the injured worker must prove that their current need for medical treatment is still related to the original claim. Thus, the insurance company may not approve any treatment without a doctor’s letter stating that the current need for treatment is still related to the original claim. In my practice, clients often call me after two (2) – five (5) years of feeling fine and now have an onset of the same symptoms they felt several years ago from their accidental injury or disabling occupational disease. Injured workers are often frustrated that their employer’s insurance company will not automatically approve a visit or treatment. This is compounded when the injured worker finds out that before treatment is approved, the employer’s insurance company is allowed to send them to the insurance company’s own “independent” medical evaluation, which often times will state that the current need for treatment is no longer related to the claim. When there has been a large gap in time from the last date of treatment until the present need for treatment usually an injured worker must participate in a hearing to request the Commission to order the treatment or visit. Scheduling of these hearings can take several months.
What should I do? First the insurance company needs evidence through medical reports that the new symptoms are related to the original injury. Then the insurer will need to verify that the requested treatment is reasonable and necessary. Finally they will investigate to ensure there was no intervening event or accident that might have caused the onset of new symptoms. The best way to get your treatment as quickly as possible is to visit your doctor and ask them to write a letter that describes what treatment has been recommended, why the treatment is recommended and whether or not it relates back to the original Workers’ Compensation claim make sure all of your providers have your workers’ compensation insurance claim number and send reports and bills directly to the insurance company to ensure time is not lost in updating the workers’ compensation insurance file. In addition, verify that your attorney also has all of the appropriate recent medical reports, thereby supporting the effective and expeditious advocacy on your behalf. If Berman | Sobin | Gross LLP was the law firm you used for the original claim we will continue to fight to get the medical treatment you need.
For More Information, Contact Attorney Julie Mirman 301-740-3306