How to Get Your Medical Treatment Approved Through Massachusetts Workers’ Compensation

  Perhaps the most common reason why injured workers seek out a workers’ compensation attorney is because their employer’s workers’ compensation insurer is refusing to authorize and pay for medical treatment that their treating physician is recommending.  Massachusetts workers’ compensation benefits provide for 100% payment of any and all medical treatment that is deemed to be reasonable, necessary and causally related to a work injury.  However, it is very common for workers’ compensation insurance companies to  either deny medical treatment or intentionally not respond to your doctor’s requests for medical treatment.  One possible reason for this is because many injured workers give up, try to use their health insurance (so the workers’ comp insurer doesn’t pay) and never get a lawyer to guide them through this difficult process.  Quite simply, although workers compensation insurers have laws and rules that they must follow in administering claims, they will do everything within those laws and rules (and sometimes outside of them) to frustrate injured workers so that they won’t seek medical treatment that they require.

The following are some tips for injured workers to follow when they are seeking medical treatment after a work-related injury:

  1. As soon as your arrive at the medical provider’s office, whether it be an emergency room, walk-in clinic or primary care doctor’s office, be absolute sure to tell them that you had a work injury and that your primary insurance is workers’ compensation insurance. If you do not know who your employer’s workers’ compensation insurance company is, call your employer’s human resources department and find out.  If your injury is serious enough that you are unable to make this call, tell the medical provider who your employer is so that they can call and find out the identify of your workers compensation insurer.
  2. Make sure that your medical provider accepts workers compensation insurance. Unfortunately the Commonwealth of Massachusetts has set the workers’ compensation medical treatment pay rates to doctors so low that many doctors are refusing to treat injured workers.  If the doctor you want to treat you does not accept workers’ compensation insurance, you need to find one who does.
  3. If the workers’ compensation insurer denies your medical treatment, make sure that the doctor’s office who requested the treatment appeals the denial within 30 days. Your doctor’s office does this routinely with all medical treatment, not just treatment involving workers’ compensation, so they should know how to handle the appeal process.
  4. If the appeal is denied, then you should contact a Massachusetts workers’ compensation attorney who can file a claim for medical benefits at the Department of Industrial Accidents. This does not cost you anything.  If your attorney is successful in obtaining medical benefits, the workers’ compensation insurer pays your attorney his attorneys’ fees.
  5. While you are waiting for your Boston workers’ compensation attorney to obtain medical benefits after filing a claim on your behalf at the Department of Industrial Accidents, if you have health insurance you may request that your medical provider bill your health insurance for the treatment that was denied by the workers’ compensation insurer. Normally health insurance policies have an exclusion for treatment made necessary by a work injury, however if the workers’ compensation insurer has issued a denial for that treatment, health insurance may pay for it and place a lien on your workers’ compensation claim pending at the Department of Industrial Accidents.

The most important thing in getting back to work as soon as possible after a work injury is to receive necessary medical treatment and to do so without any unnecessary delays caused by your workers compensation insurer denying medical treatment or not responding to requests for treatment requested by your medical providers.  Most people who are injured at work are dealing with the workers’ compensation process for the first time and find it extremely frustrating.

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