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Alabama Workers Compensation Questions Who Controls Medical Treatment

Alabama Workers Compensation Questions Who Controls Medical Treatment

Alabama Workers Compensation Questions: Who controls Medical Treatment? Who controls my medical treatment? For some reason, there appears to be some disagreement over this question. If you go to the Alabama Department of Labor's website and look under their frequently asked questions, there response to this question is that your employer (actually their workers compensation insurance carrier) controls your medical treatment, but this is not the case.

Yes, the workers' compensation laws in Alabama allow the employer/insurance carrier to pick the initial treating physician, but their control basically ends here. As long as the treatment recommended by the authorized treating physician is reasonably necessary, the employer is legally responsible to pay for said treatment, whether or not the employer likes what the proposed treatment is, who performs said treatment or where it is carried out. The authorized treating physician is also free to refer you to any specialist they deem reasonably necessary as well; they do not need the approval of the workers compensation insurance carrier as long as their decision is reasonably necessary given your condition.

It is true that if the workers compensation insurance carrier does not like what the authorized treating physician recommended in terms of medical treatment, then they have the right to use the utilization review process and hire another physician to review the findings of the authorized physician and opine if they agree with the doctor's findings. Utilization review (UR) typically works like this. Your treating physician informs you that 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 state 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 contrived standard designed by the workers compensation insurance carrier, 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 or a loved one suffered a work injury and you have questions about your right to Alabama Workers' Compensation benefits, don't hesitate to contact and talk with one of the experienced Alabama Workers Compensation Lawyers at Powell and Denny today.

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Alabama Workers Compensation Questions Who controls Medical Treatment

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