At some point, many injured workers find themselves in a confusing position regarding their medical care. The workers' compensation adjuster has approved your choice of physician and you visit with the doctor for an evaluation. Thereafter, the doctor makes treatment recommendations and submits them to the adjuster for approval. The adjuster responds and sends a decision to you and your doctor
DENIED.
Now what?
The process for obtaining medical treatment can be very complicated. Initially, your doctor needs to submit a Form 1010 specifically outlining what type of treatment is requested. Some of the information needed along with the 1010 includes the history of injury, physical findings, imaging results and treatment plan. Without this information, the 1010 will be denied. The 1010 is faxed to the adjuster and a decision must be made within five business days. If no decision is rendered within five business days, the treatment is considered to be denied.
Once treatment is denied, any aggrieved party may file an appeal called a Disputed Claim for Medical Treatment, Form 1009. The completed 1009 must be submitted to the Office of Workers' Compensation Administration (OWCA) within fifteen calendar days of the 1010 denial. Additionally, a copy of the 1010 and all relevant medical records must be submitted along with the 1009. Once the appeal is timely submitted, the Medical Director of the OWCA will review the appeal and make a decision about whether the treatment should be approved.
Complicated, isn't it?
To state it simply, this is not an easy process. We have successfully handled these types of appeals in the past and we look forward to helping you. Mensman Law is committed to getting the treatment you are entitled to under the law.
