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Alabama Workers' Compensation Attorneys ProPublica Story

Alabama Workers' Compensation Attorneys ProPublica Story

Alabama Workers' Compensation Attorneys ProPublica Story: A few weeks ago ProPublica, along with NPR, issued a two series report on the state of workers' compensation benefits in the United States (click here for the initial story). PBS' NewHour also did a segment on the story. At the same time the Occupational  Safety and Health Association (OSHA) and the U.S. Department of Labor released their own reports on the plight of injured workers. Their joint opinion: injured workers are having a tougher time obtaining the necessary medical care they need in order to recuperate from their injuries so they can return to work AND the amount of monetary compensation is falling further behind.

Since these initial reports, Pro Publica and NPR has released two additional studies, which continue to highlight the plight of injured workers in the United States. In the most recent report (here), an emphasis is placed in reviewing a trend in workers' compensation claims which has been a problem in Alabama for nearly a decade-that of utilization review.

Before any discussion of utilization review (UR) is had, one has to understand that in Alabama, the law is clear, in a compensable workers compensation claim, the comp carrier shall pay for any medical treatment which is reasonable and necessary. Reasonably necessary treatment means that the treatment recommended is reasonable given your condition. The treatment does not have to be the only form of treatment available; it does not have to be the best (as opinions on such matters will vary from physician to physician); it does not have to be the cheapest form of treatment available (to the chagrin of the workers compensation insurance carrier), it just has to be reasonable, and common sense tells you that a doctor would not recommend a form of treatment which was not at least reasonable.

Utilization review (UR) typically works like this. Your treating physician (the one workers' compensation tells you to see) informs you that an expensive test or surgery is needed. At this time the workers' comp insurance provider hires a physician in another State to review some of your medical records and give an opinion as to whether the suggested treatment meets the insurance provider's definition of medical necessity. Not surprisingly, the doctor hired by workers comp generally states that the requested treatment does not met this contrived standard, surgery is then denied and you are informed that the surgery is not needed.

If this has happened to you, do not let the insurance carrier get away with it; to date, I do not know of a single instance where a judge in Alabama has upheld a UR denial of treatment. The judges know what the definition of "reasonably necessary" is and give little credence to the findings of a doctor in another State who has never seen you and who is not aware of what the standards are in Alabama.

If you suffered a job injury, it is in YOUR interest to speak with an experienced Alabama Workers Compensation Attorney to protect your interest, as the insurance adjuster won't.

If you were hurt at work and you have questions about your right to Alabama Workers' Compensation benefits, don't hesitate to call and talk to one of the experienced Alabama Workers' Compensation Attorneys at Powell and Denny today.

Powell and Denny: We Work When You Can't

Offices located in Birmingham, AL and Huntsville, AL

Alabama Workers' Compensation Attorney ProPublica Story

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