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Birmingham Work Injury Attorney Medical Treatment Denied

Birmingham Work Injury Attorney Medical Treatment Denied

Birmingham Work Injury Attorney Medical Treatment Denied: Last week an article was posted detailing the difficulty a severely injured worker in California-Mr. Donovan Dixon- was having receiving needed medical care; unfortunately, his story is all too common in Alabama and throughout America. The facts are as follows: On October 27, 2013, Mr. Dixon was driving a tanker truck in Commerce, CA. A truck in front of him lost its rear axle, causing a bad wreck. Mr. Dixon's rig jackknifed over the freeway overpass and caught fire. Mr. Dixon-covered in oil and on fire-kicked out his front windshield and jumped 70 feet down. Miraculously he survived, but with burns over 60% of his body and suffering with a fractured pelvis, a fractured sacrum; he lost part of his intestines, suffered kidney failure; he was in a coma for 3 months and spent 8 months in the hospital.

This event was captured on television, so there was no way for the workers compensation insurance carrier to deny liability.

Not surprisingly, Mr. Dixon is still suffering from the effects of his injuries, but that doesn't mean that the workers comp carrier agreed to pay for the medical treatment Mr. Dixon still needs. The comp carrier has repeatedly denied Mr. Dixon physical therapy and a hospital bed that was ordered by his treating physician. The bed is needed to help Mr. Dixon deal with bed sores. A local business ended up giving Mr. Dixon a hospital bed which AIG-the workers compensation insurance carrier-has refused to provide him after the treating physician stated it was necessary for Mr. Dixon (the story is here).

Part of the reason the workers comp carrier gave for their denial of physical therapy and a hospital bed was because they did not believe Mr. Dixon was trying hard enough to get better after his job injury.

Another proffered reason was that doctors who had never treated Mr. Dixon-doctors paid directly by the workers comp insurance carrier-opined that the requested treatment was not really needed. This process is known as Utilization Review.

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.

Mr. Dixon lives in California. 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. But that doesn't mean that every day in Alabama an injured worker is not informed that the medical care his treating physician ordered has been denied based on a UR opinion. This is where an experienced Alabama Work Injury Attorney can be invaluable.

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 work 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 Work Injury Attorneys at Powell and Denny today.

Powell and Denny: We Work When You Can't

Offices located in Birmingham, AL and Huntsville, AL

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