Episode 138: Kentucky workers’ compensation attorney Jeff Roberts answers the question, “Why is my medical care getting delayed?” There are many reasons why this might happen. But with almost 34 years of experience, Jeff understands how to minimize and possibly avoid delays for injured workers.
If you been injured on the job, you should be covered by your employer’s workers’ comp policy. Medical treatment is a significant part of the benefits you deserve. Under workers’ compensation, there are no co-pays or deductibles. Unfortunately, there are times during which delays can occur. This doesn’t mean the treatment is getting denied. Rather, something may be going on in the case that doesn’t seem to makes sense. That’s when having an experienced workers’ comp attorney can resolve the delay and enable you to receive the treatment you need.
The law gives the insurance company time to investigate your injury and to determine that it was, in fact, work-related. It may be a situation in which your employer hasn’t notified the insurance company in a timely manner. This process may result in a delay in getting your workers’ comp file setup and assigning a representative to handle your workers’ comp claim.
Why Did I Have to Pay a Co-Pay for My Work Injury?
If the file hasn’t been setup, you won’t have a claim number or the necessary pre-certifications. If this happens to you, keep a copy of any co-pays you had to initially pay and you can get reimbursed for that expense. You can also get reimbursed for any mileage you incurred going to your work injury-related doctor appointments. This is especially important if you have to travel to see a specialist. You have a 60-day window to submit the reimbursement form. This form can be found in Episode 68.
Understand Your Duty to Notify Your Employer
Under Kentucky law, you have a duty to notify your employer of a work-related injury, even if you’re not sure you need medical treatment. This notification must be made to your supervisor, manager or someone higher in the chain of command. This gives the employer an opportunity to correct the situation, so others don’t get hurt. It doesn’t mean you can’t get workers’ comp benefits, it is however, an important step in the process. Understand, though, that if you fail to notify your employer, this is grounds for the denial of benefits. However, there is no 24-48 hour notification time limit. Just make sure you do it as soon as you can. Jeff explains your duty to notify in Episode 72.
Why Did I Get Flagged for Utilization Review?
This is fairly common with a workers’ compensation claim. It doesn’t necessarily mean the treatment you and your doctor are requesting will be denied. The insurance company has the right to make sure the treatment is reasonable and necessary. This applies to specific treatments, specialists and even medical prescriptions.
The insurance adjuster will send your medical records to a person who will review the notes, what type of treatment is being requested and other details. This information will be checked against ODG guidelines and either approved, conditionally denied, or denied. That decision can be appealed by either side. There may be other types of treatment that need to be exhausted before the recommended treatment can be approved.
It may be necessary for your attorney to take the petition to the judge to argue for why the treatment should be allowed. Again, this can cause a delay in your medical care.
Lack of Communication Can Cause a Delay in Medical Care
A lack of communication between the attorneys, the doctor and attorneys, or between other parties can slow down the process and cause delays in medical care. This is common when a procedure is waiting on an approval. Jeff can help to expedite the communication by requesting the doctor provide him with a copy of the paperwork. He will forward it to the adjuster to get it approved. Sometimes, mistakes happen and someone simply dropped the ball. Unfortunately, that causes delays for the injured worker.
If there is a rehabilitation nurse involved, there are times in which she/he can help to expedite the approval for treatments, such as an MRI. These nurses do not work for the doctor. They work for the insurance company. The have a direct line of communication with the insurance company and are helpful. However, it’s critical that she/he comply with the stipulations Jeff sets forth, to ensure they aren’t influencing the doctor’s choice of treatment. This is often attempted in effort to save money for the insurance company.
Lack of Legal Knowledge Can Cause a Delay in Medical Care
There are situations in which either the medical provider or others don’t fully understand the laws regarding workers’ compensation. It’s simply not their area of expertise. This can become particularly important when there is a pre-existing condition.
In Kentucky, a pre-existing condition that was made worse by a work activity or workplace injury, can still qualify for workers’ comp benefits. If the condition was considered “dormant” before the injury, but was “activated” by the injury, the medical treatment should be 100% covered by workers’ comp. Degenerative disc disease is a common example.
Listen to Episode 30, What If I Have a Pre-existing Condition, for more information on this specific issue.
Insurance companies may try to shift the responsibility and escape financial liability by blaming your medical situation on a pre-existing condition. Jeff is often able to overcome that tactic either in negotiations, or in front of the judge.
Communication between You and Your Attorney Is Vital
Over the past almost 34 years of practice, Jeff has learned how important it is to keep clients informed about what may happen as the claim progresses. He works diligently to make sure he helps clients understand their options. This “small town service” approach is much appreciated by clients who are able to anticipate the next steps.
Jeff offers free, initial consultations to ensure you have the information you need to decide your best options.
We hope you found this episode insightful and helpful.
Thank you for listening!
What Do Other Clients Think About Jeff?
We always encourage listeners to read the Google Reviews Jeff Roberts has received from many of his clients. A 5-Star rating and the comments are earned recognition and demonstrate Jeff’s commitment to his clients. As a solo attorney, he has more Google Reviews than some firms with multiple attorneys. Jeff shares the credit with his staff at the Roberts Law Office. Successfully representing injured clients is a team effort. It’s why Jeff likes to say his firm offers “Small Town Service with Big City Results.”
Jeff Roberts Represents Injured Clients Throughout Kentucky
With offices located in Calloway County (Murray) and now in Christian County (Hopkinsville), Jeff has a history of representing personal injury clients, workers’ compensation clients and social security disability clients across the state. He’s represented clients from Paducah, Bowling Green, Louisville, Covington, Whitesville and many other Kentucky locations. He’s not just a Western Kentucky injury attorney.
Is It Time to Speak with an Attorney about Your Workers’ Compensation Claim?
The office phone number is (270) 753-0053 or toll free at 800-844-5108. For more information, visit www.JeffRobertsLaw.com. This podcast is meant to provide information and is not legal advice. Jeff’s principal office is located at 509 Main Street, Murray, Kentucky. Co-host Jim Ray is a non-attorney spokesperson. This is an advertisement.
