Your Right To Medical Care As A Tennessee Injured Worker

Medical Treatment Issues In Workers' Comp[1]

By Jason G. Denton

When dealing with medical treatment in workers' compensation situations, the ultimate goal for all parties involved is to restore your health back to the pre-injury status. The medical world calls this Maximum Medical Improvement or what is commonly referred to as "MMI".

As with all things in life, time changes all. In 2004, major changes in the workers' compensation statute limited the amount of your recovery for workers' compensation injuries. Unfortunately, the insurance carriers did not stop there. The insurance companies have found another way under the laws to limit your benefits.

As I have mentioned in other articles, you are entitled to reasonable and necessary medical treatment as an injured worker. Workers' Compensation law requires that the Workers' Compensation insurance carrier provide you with an authorized treating physician, commonly known as an "ATP". The carrier selects the ATPs and puts three of them on a panel, from which you are to choose one out of three. The carrier got to choose the doctors from which you could choose-so from the start it would seem that the carrier has the upper hand in picking doctors that will be cautious about recommending unnecessary treatment. That's not enough for the insurance companies, though!

For example, if the ATP-the doctor the carrier put on the panel-decides that you need an MRI, physical therapy, or surgery, the carriers' are using a new loophole to deny you that medical treatment. What I regret to report to you is that the law is helping them do it.

After the ATP orders the medical treatment or procedure, if the carrier does not like what the ATP says or has ordered, the carrier elects to send the request out for what is called Utilization Review, commonly known as "UR". In UR, the carrier hires a third-party insurance company to second-guess their own panel physician. In my experience, 95% of our cases that go to the carrier's UR agent result in a denial of the medical treatment that was ordered by the ATP.

Once this happens, it is up to the ATP or you to appeal the denial. According to the Tennessee Department of Labor, you or the ATP must appeal the UR denial of medical treatment. Failure to timely file an appeal on a UR denial will prevent you from reaching MMI and getting reasonable and necessary medical treatment that you may be entitled to otherwise.

Therefore, as soon as you are notified that your MRI, physical therapy, or any other procedure has been denied, you must take action immediately. Your health depends on it.

This is a battle we fight for our clients on almost a daily basis. By playing this UR game, carriers are able to not only save money by denying medical treatment, they are also able to stall an employee's recovery for permanent disability benefits, which are generally assessed only after an employee reaches MMI.

If you are facing a similar situation, it is important that you take immediate action, and consider seeking legal representation if you have not already.

Please call or click to discuss your work related injury with a real attorney at The Williams Law Group. We can help!

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[1] This article does not constitute, nor is it a substitute for, legal advice. Legally and ethically I am not allowed to give legal advice until I meet with you and review the particular facts and circumstances of your cases after we agree to enter an attorney/client relationship. I have created this publication with the intent of providing the reader with accurate information concerning the subject matter covered, however it is not in any way intended to give or constitute legal advice, or to serve as a substitute for the advice of your own legal counsel about your case. By creating and publishing this article, neither I, nor any attorney with the Williams Law Group is engaged in rendering legal or other professional advice, and this article is not a substitute for independent research, assessment, or advice from an attorney. If you require legal or other expert advice, you should seek the services of a competent attorney or other professional.