How To Get Medical Care When Your Claim Is Denied?

If your case is denied by the insurance company, the workers compensation insurance company will not pay for medical treatment until either the claim is accepted or a workers’ compensation judge orders the insurance company to pay for medical treatment. As a result, it may take a long time to get the workers’ compensation insurance company to pay for medical treatment in a denied case.

If you are covered under your group health insurance, your spouse’s insurance, or are covered under a government program such as Medicare or MediCal, you can get treatment under those policies or programs. Once you let the group health insurance or government program know that the workers’ compensation insurance is refusing to provide medical treatment or a particular medical procedure or surgery that is required, they have to provide you with the medical treatment. You should be prepared to give these entities your workers’ compensation case information so that they can file a lien for medical treatment in your workers’ compensation case. This lien is not a lien against your compensation.

You may be able to find a doctor who will provide treatment and wait to be paid later. That doctor will file a lien in your case. This lien is not a lien against your compensation. If asked by the doctor, you should sign the green lien form so they can file a lien for medical treatment in your workers’ compensation case.

If your claim is accepted, but the workers’ compensation insurance company refuses to provide treatment such as a surgery or medications, you should also attempt to obtain payment for treatment from other insurance or government programs if available. You will obtain this treatment much quicker waiting for an AME, QME, or Workers Compensation Judge to make a decision in your case.

If your private insurance is refusing to pay for treatment that is being denied by the workers’ compensation insurance company, please call this office immediately so that you can be referred to an attorney who specializes in bad faith insurance claims practices.