Work Comp Trend: Insurers Denying Medical Care

Work Comp Trend: Insurers Denying Medical Care

The worker's compensation arena in Missouri changes on a regular basis. Insurance companies come and go and they also change the way they choose to handle cases. Recently, our law firm has noticed that adjuster's are not approving necessary medical care even against the advice of their own counsel. In the last month alone, I have had three different clients faced with this situation.

For instance, I have a client with a shoulder surgery. The authorized treating physician wanted my client to have physical therapy three times a week for six weeks, which would obviously be eighteen visits. For whatever reason, the adjuster thought that five visits with physical therapy would be appropriate and only authorized five visits. I sent a couple of letters and called the defense attorney asking for an explanation as to why the physical therapy was not approved and the adjuster said simply that he did not have an explanation. As a result, I filed a hardship petition and I noticed up the defendant's adjuster for a deposition. The evening before we were scheduled to go to Court, I received a letter indicating that the physical therapy as prescribed by the doctor is now authorized. The defense wanted to know whether or not I was still taking the deposition of the adjuster. I feel that insurance adjusters must be held accountable and cannot simply disregard the law or my client's rights.

As this case is progressing, I have another file where the defense and insurance company failed to file a timely answer. In Missouri, an answer must be filed within thirty days. If not, the claim is deemed admitted. I am an authority on this area of worker's compensation law as I set the law before the Court of Appeals in a case called T.H. v. Sonic Drive Thru. As a result, our claim is deemed admitted. Despite the fact that our claim is true, and despite the fact that they have no legal defense, the employer chose not to authorize care. Again, I also filed a hardship and inquired as to why the medical care was not being provided. I received a similar response. That case is now set for a hardship hearing on June 5, 2014 and the employer/insurer has reconsidered their position and is now authorizing care.

This is a changed landscape from even a year ago. I think that the insurance companies have done an assessment of the legal arena and realize that too many lawyers are unwilling or unable to try these workers' compensation claims to a conclusion. Ineffective lawyering by others harm the entire Claimant population because weak lawyers allow insurance companies to make bad decisions that affect us all. At Cantor and Associate, we are dedicated to making sure that the employer or insurer is held to the obligations of the law. Unfortunately, these legal obligations are all slanted in favor of the employer, but still, insurance companies do not want to pay and create an invalid reason not to pay. Too many lawyers allow this to occur.

In summary, if you have a claim, you must receive all the medical care related to that injury and it needs to be provided by the employer/insurer. It is not sufficient to leave that battle for a later time or not fight out the issue. If you need help and are unrepresented call us at (314) 542-9999. If you are represented, call your lawyer and tell them to do what you hired them to do, which is pursue your case. I wish you health and a speedy recovery from your work injury.

POSTED IN: Mark's Post Workers' Compensation

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