What Happens If My Employer or Workers Compensation Carrier Refuses to Authorize Medical Treatment?

What Happens If My Employer or Workers Compensation Carrier Refuses to Authorize Medical Treatment?

One of the most important benefits available to an injured worker under Alabama’s Workers’ Compensation Act is medical treatment. In fact, if your injury is covered, your employer—through its workers’ compensation insurance carrier—is responsible for providing and paying for all reasonably necessary medical treatment related to your work injury (see Ala.Code).

But what happens when the workers’ compensation carrier refuses to authorize treatment?  What if your doctor recommends an MRI, surgery, physical therapy, pain management, or a referral to a specialist, and the insurance company simply says “no”?

Many injured workers assume they have no options, but that is not always true.

The General Rule: The Employer Controls Medical Treatment

Under Alabama workers’ compensation law, the employer generally has the right to direct medical care through an Authorized Treating Physician.  As long as the employer is providing reasonably necessary medical treatment, the injured worker is usually required to follow the authorized treatment process.  But What If Treatment Is Not Being Provided?

The law imposes obligations on both sides. While the injured worker must generally cooperate with authorized treatment, the employer and workers’ compensation carrier must provide the medical care required by law.  Problems arise when treatment is repeatedly delayed, referrals are not approved, medications are denied, diagnostic testing is refused or the carrier simply ignores treatment recommendations.  At some point, a refusal to provide necessary medical care may become a failure to fulfill the employer’s obligations under the Workers’ Compensation Act.

Can an Injured Worker Seek Treatment Elsewhere?

Under certain circumstances, Alabama courts have recognized that when an employer neglects, refuses, or fails to provide reasonably necessary medical treatment, an injured worker may be justified in seeking treatment elsewhere.  The reasoning is straightforward-an employer cannot refuse to provide necessary medical care and then complain when the injured worker seeks treatment to address the injury. However, this is not something an injured worker should assume applies automatically.  Whether outside treatment will ultimately be the responsibility of the employer often depends on the specific facts of the case.

When treatment stalls, the injured worker may be left in a difficult position—still injured, unable to work, and unable to obtain necessary medical care.

Before Seeking Treatment on Your Own

Because Alabama workers’ compensation law contains specific rules regarding authorized treatment, injured workers should be cautious before independently scheduling treatment and assuming the workers’ compensation carrier will pay for it.

Questions often arise regarding:

• whether treatment was truly denied
• whether the delay was unreasonable
• whether the treatment was medically necessary
• whether proper notice was provided

For that reason, it is often wise to understand your legal rights before incurring significant medical expenses on your own.

What Should You Do If Treatment Has Been Denied?

If your authorized treating physician has recommended treatment and you are experiencing delays or denials, it may be helpful to contact an experienced Alabama workers’ compensation attorney for assistance as the sooner the issue is addressed, the more likely it is that treatment can be obtained before your condition worsens.

If you have suffered a job injury and you have questions about your rights and benefits under Alabama’s workers compensation laws -don’t hesitate to contact and speak with one of the experienced Alabama Workers Compensation and Social Security Disability attorneys at Powell and Denny today for a free consultation. Appointments are available in person, or virtually via Zoom if more convenient.  Powell and Denny would appreciate the opportunity to help.  And remember, there is no fee unless you win.

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