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Workers’ compensation and the independent medical review

On Behalf of | May 29, 2023 | Worker's Compensation

Has a workplace accident left you with injuries that prevent you from working and living your normal life? If so, then you’re probably trying to figure out how to navigate the road ahead. It may not be easy, either. Although you might be able to rely on workers’ compensation benefits to provide you with some stability while you focus on your recovery, your employer and their insurance company might try to push you off benefits more quickly than you’d like.

For this reason, you need to be prepared to advocate for yourself throughout not only the claims process, but during the entire time that you receive workers’ compensation benefits. This is because your employer and their insurance company may dispute your need for ongoing medical treatment and your inability to return to work at any time, which could threaten the benefits that you’re receiving.

What you need to know about the independent medical review

Before your treatment can be approved through the workers’ compensation system, it will be subjected to a utilization review. Here, your proposed treatment is analyzed to determine if it’s medically necessary to treat your condition that was caused by the workplace accident in question. If the treatment is deemed necessary, then you’re good to go without issue. If, on the other hand, your treatment isn’t deemed necessary for your condition, then it’ll be denied.

At that point, you can request that the determination be subjected to an independent medical review. Through this review, independent medical professionals review the results of the utilization review along with your medical records to make an ultimate determination as to whether the proposed treatment is reasonably necessary to treat your work-related injuries.

Therefore, you’ll need to make sure that you’re organized and that you file all necessary paperwork in a timely fashion. If you don’t, then you might not be able to receive the medical treatment that you need. This can be a starting point for an insurance company to try to restrict your access to the benefits that you need.

What if you’re denied treatment?

Being denied treatment can feel like a punch to the gut. However, just because you’re denied one form of treatment doesn’t mean that your workers’ compensation benefits are going to evaporate immediately. Therefore, if you’re denied one form of treatment, then you might want to talk to your doctor about alternatives that could give you broader protection under the workers’ compensation system.

That said, you should be aware that denied treatment could spur your employer’s insurance company to request an independent medical examination. Here, your injuries will be reevaluated to determine if they’re still severe enough to prevent you from returning to work.

If you’re commanded to submit to one of these examinations, then you’ll want to make sure that you can clearly articulate your pain and how your injuries have prevented you from engaging in activities related to your work. You’ll also want to be able to speak to the treatment you’ve already received and your doctor’s treatment recommendations in light of the denial of care that you received through the independent medical review.

Don’t get lost in the intricacies of the workers’ compensation system

There are a lot of nuances to the workers’ compensation system. And you have to know how to adequately navigate all if them if you want to protect your ability to obtain and maintain your benefits.

That can be hard to do when you’re unfamiliar with the process, though, which is why it’s a good idea to learn as much as you can about these intricacies. Hopefully then you’ll be able to obtain outcomes that allow you to focus on a robust recovery and returning to work.