This is a situation that the attorneys here at Abbott, Clay & Bedoy, LLC hear all too often. Many times the first time a client knows that there is a problem with the insurance company and their workers’ compensation claim is when medical care starts being denied by the insurance company.
Denial of medical care is, obviously, a serious issue for an injured worker and the insurance company can deny medical care for a host of reasons. They have an army of their own doctors doing evaluations of medical care by the injured worker’s treating doctors. Often times medical care can be denied simply because the insurance doctors say that it is not medically necessary, and they can do this without every actually examining the patient.
Other times the reason for denial can be more complex. The insurance company will often times claim that the injury is not as severe as the injured worker, or treating doctors say that it is. This is called an extent of injury dispute. If an insurance carrier files an extent of injury dispute, in essence what they are saying is that they are only responsible for paying for the medical care related to what they say the injury is. For instance, a treating doctor may say that based on their examination and on the diagnostic testing done that you, as the injured employee have herniated discs in your spine that needs a combination of treatments and possible surgery.
The insurance company can claim that the only injury that occurred at work was a sprain or strain to the back, essentially a muscle pull, and deny that any other injury occurred. At this point, they will not pay for any medical care related to your herniated discs, this delays medical treatment, greatly increases the time it will take for you to recover; and relates directly to both your right to financial benefits due to you because of your injury and to the time off that you need to properly heal from the injury that you sustained at work.
Denial of medical care is a serious issue, with serious repercussions to you, your health, your finances, and your future. You need an experienced team of attorneys with a wealth of knowledge about the Texas workers’ compensation system working for you to navigate this extremely complex issue. To fight for your rights, to make sure that you get the right medical treatment and to work with medical providers to make sure that you get the help that you need to get through this traumatic ordeal.
The insurance company’s job is to get you, the injured worker back to work as soon as possible with as little missed time, and spent money as possible. Don’t let them take advantage of you. The lawyers and staff here at Abbott, Clay & Bedoy, LLC understand, and we are here to help. Let us fight the insurance company, to make sure you get the justice and medical care that you deserve.