Dealing with a Denial of Treatment

My treatment was denied! What can I do?

If you’ve sustained a work-related injury and already have an active workers’ compensation claim, treatment requested by your doctor may still be denied. In many cases, treatment is denied as allegedly being related to physical or psychological conditions that have not yet been recognized as related to your industrial injury. In some cases, plan for care is denied as being excessive or not medically necessary. Regardless of the reason provided for the denial, you have the right to file an appeal for treatment of your workplace injury.

There are two main types of employers in the context of workers’ compensation insurance coverage. Employers are commonly referred to as self-insured employers or state-fund employers. In the case of self-insured employers, you have the right to immediately request a hearing before the Industrial Commission regarding authorization of treatment denied by your employer (often through its agent called a third-party administrator or “TPA”). In the case of state-fund employers, treatment denials must be appealed and advanced through the Bureau of Workers’ Compensation’s administrative dispute resolution (“ADR”) process. If the BWC ultimately issues an order denying requested treatment, you may then file an appeal advancing the issue to the Industrial Commission for a hearing. Understanding the proper channels, forms, and processes for an appeal in your unique case can be challenging. Successful processing of an appeal often requires additional documentation from the requesting doctor. In some cases, before appropriate treatment can be authorized, additional conditions must be added to the claim.

If you’ve received a treatment denial, don’t hesitate to contact the experienced legal team at Larrimer & Larrimer, LLC. We have almost 100 years of workers’ compensation experience fighting for the benefits and treatment of Ohio’s workers injured on the job.