October 1, 2019 | Workers' compensation

If you have been hurt at work, you may know that your employer (or, more likely, their workers’ compensation insurance company) has to pay for your medical treatment for your injuries. However, insurance companies go by what your doctor puts in writing, not what he or she tells you in your examination. Therefore, it is always a good idea to request any recommendations in writing and signed by the doctor. It could be weeks before the office note gets to the adjuster to consider whether to approve a recommended diagnostic test or treatment, and that can delay your recovery. If your doctor recommends an MRI, get a copy of that recommendation so you can send it to the adjuster immediately.

If your doctor is recommending something that is fairly typical for your injury (like a lumbar MRI for a low back injury), you may not need the paperwork to set forth the reason for the recommendation, but getting that never hurts. When a doctor recommends something that is related to your injury but is outside the norm, some explanation may be necessary. For example, if your doctor recommends a back surgery for a work injury but says that you need to wait until you quit smoking or lose weight before you can have surgery and he or she prescribes medicine or other intervention to help with that, some explanation of how the need for treatment relates to the injuries will be necessary before the insurance company will even consider paying for it.

For any medical expense to be paid, you have to show that it is reasonable, necessary, and causally related to the work injuries. Having your doctor address those elements in a note will go a long way in ensuring that your treatment is not delayed.

We have many consults that come to us because of a medical bill denial, and oftentimes those can be corrected by simply asking the doctor whether the bill or proposed treatment is reasonable, necessary, and related to the injuries from the work accident and getting the answers in writing. Doctors are not workers’ compensation experts and they may leave out a phrase in the note that is necessary. They may explain in great detail to you in the exam why you need a particular treatment, but if it isn’t written down, the insurance will not consider it and may use that as a basis to deny your treatment.

The most important thing to remember is to talk to your doctor about what treatment you need and the reason you need it. If it is because of a work injury, make sure not to leave the office without a written recommendation for the treatment and the reason you need it from your doctor. You can then forward that to the adjuster to avoid delay that can be caused if some information is missing or if it takes the medical office some time to get the visit notes to the insurance company.

If you have question about medical treatment under the Nebraska Workers’ Compensation Act, give us a call 402-933-3345.