Alabama Workers Compensation Questions: (9) Does Workers Comp have to pay for all of my medical treatment?

Alabama Workers Compensation Questions: (9) Does Workers Comp have to pay for all of my medical treatment?

As we discussed in our last blog, your employer’s workers compensation insurance carrier has to pay for any and all medical treatment which is reasonable and necessary given your injuries. Unfortunately, in the past few years getting the insurance carrier to authorize medical treatment for those who have suffered job injuries. In the majority of situations we see, the difficulty in getting medical treatment approved does not lie with the medical treatment recommended by the doctor chosen by the workers’ comp insurance carrier, but with the fact that the insurance carrier simply does not want to pay for the reasonable and necessary treatment.

Ala.Code §25-5-77(a) states “…the employer…shall pay [for all] reasonably necessary medical and surgical treatment and attention, physical rehabilitation, medicine, medical and surgical supplies, crutches, artificial members, and other apparatus as the result of an accident arising out or and in the course of the employment….” This section is not open to misinterpretation; it unequivocally states that the employer shall pay for all treatment which is reasonably necessary given the injured workers’ condition. Given this clearly worded section, why has the difficulty in getting medical treatment approved become such a problem?

Usually, the difficulty arises when the workers’ compensation insurance carrier pays a doctor, who never sees the injured worker, to render an opinion as to whether the treatment recommended by the authorized treating physician is “reasonable and necessary.” Not surprisingly often the non-examining doctor, who is paid directly by the insurance carrier, decides that the recommended treatment (which can be costly) is not reasonably necessary.

The decision to deny approval recommended medical treatment is rarely upheld by a judge, as “this standard is one of reasonable necessity, not absolute or strict necessity; this standard does not necessarily limit the parties to the single ‘best’ treatment available. Nothing in the Act suggests that there can be only one ‘reasonably necessary’ approach to treating a given patient and his or her injury or illness…” Ex parte Southeast Medical Center, 835 So.2d 1042, 1045 (Ala.Civ.App.2002).

If you are having difficulty getting the medical treatment recommended by your treating physician approved, the experienced Alabama Workers Comp Lawyers at Powell and Denny would be happy to discuss your case with you free of charge.

Powell and Denny: We Work When You Can’t

Offices in Huntsville, AL and Hoover, AL

Powell and Denny have been selected as one of the Best Law Firms by U.S. News and World Report for each of the last 5 years, have been selected as one of Birmingham’s Top Lawyers by B-Metro Magazine for the last 3 years, have been selected by The National Advocates as one of the Top 20 Workers’ Compensation Firms (plaintiffs) and Powell and Denny, P.C.-has been selected as one of the “Best of the Best” law firms by The American Registry.

 

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