Boston Workers Compensation Lawyer Blog
When you’ve been injured at work in Massachusetts, one of the biggest concerns is making sure you get the medical treatment you need. Workers’ compensation insurance is designed to cover reasonable and necessary medical treatment related to your injury. But the process isn’t always straightforward—insurance companies often delay or deny approvals, leaving injured workers frustrated.
If you’re wondering how to get your treatment authorized, this guide breaks down the steps and explains what you can do to protect your rights.
Understanding Your Rights to Medical Treatment in Massachusetts
Under Massachusetts workers’ compensation law (M.G.L. c. 152), injured employees are entitled to:
- Payment of medical bills for treatment that is reasonable, necessary, and related to the work injury.
- Coverage for doctor visits, surgery, physical therapy, prescriptions, and diagnostic tests.
- Reimbursement for travel expenses to and from medical appointments.
Importantly, the law requires the workers’ comp insurer to pay for these costs—not you. However, getting the treatment approved often requires navigating insurer rules and medical review processes.
Step 1: Report Your Injury Right Away
The approval process starts with properly reporting your injury. Tell your employer about the accident as soon as it happens. If possible, submit a written report that documents:
- The date, time, and location of the accident
- How the injury occurred
- Any witnesses
Delays in reporting can make it harder to link your treatment to the workplace injury, giving insurers a reason to deny or delay care.
Step 2: See the Right Medical Provider
In Massachusetts, your employer (or their workers’ comp insurer) has the right to send you to an initial medical provider for the first visit. After that, you can choose your own doctor or specialist.
To improve your chances of approval:
- Choose a provider familiar with workers’ compensation cases.
- Make sure your doctor clearly documents that the injury is work-related.
- Follow your doctor’s treatment plan closely—missed appointments can hurt your case.
Step 3: Get Pre-Approval for Certain Treatments
Routine visits and medications are usually paid without pre-approval. However, surgery, advanced imaging (like MRIs), and extended therapy sessions often require prior authorization from the insurance company.
Your doctor’s office should submit a treatment request form to the insurer. This is reviewed under the state’s Utilization Review (UR) process, which determines if the treatment is medically necessary.
If the insurer approves, you can move forward. If not, you may need to appeal.
Step 4: Responding to a Denial
It’s common for insurers to deny or delay medical treatment requests. Reasons include:
- Claiming the injury wasn’t work-related
- Arguing the treatment isn’t “reasonable or necessary”
- Suggesting a less expensive alternative
If your treatment is denied:
- Request the denial in writing so you know the stated reason.
- Ask your doctor to provide a detailed medical report supporting why the treatment is necessary.
- Consider filing a claim with the Massachusetts Department of Industrial Accidents (DIA).
At the DIA, a judge can review the evidence and order the insurer to cover the treatment.
Step 5: Work With a Workers’ Compensation Lawyer
While you can try to navigate the process alone, insurers have experienced adjusters and lawyers working to minimize costs. Having an attorney levels the playing field.
A Massachusetts workers’ compensation lawyer can:
- Make sure all medical requests are submitted correctly
- Gather strong medical evidence to support your treatment
- Represent you at DIA hearings if the insurer denies care
- Push back against delays and protect your right to ongoing treatment
Final Thoughts
Getting medical treatment approved through Massachusetts workers’ compensation insurance can feel overwhelming, especially when you’re trying to heal from an injury. The key steps are to report your injury quickly, choose the right doctor, ensure proper documentation, and appeal denials if needed.
If your treatment request has been delayed or denied, don’t give up. With the right legal help, you can often get the care you need and deserve.
Need Help Getting Treatment Approved?
At Carney, Rezendes & Crowley, we’ve helped countless injured workers across Massachusetts secure the medical treatment and benefits they’re entitled to. If your workers’ comp insurer is standing in the way of your recovery, we’re here to fight for you.
📞 Call us today for a free consultation and let’s make sure you get the care you need.
