Were Your Medical Workers’ Comp Benefits Denied?

Medical coverage is a valuable aspect of workers’ compensation benefits. If you suffered a job-related injury or illness, you deserve to have your medical treatment covered. The reality is that your employer and their insurance company are financially motivated to delay or deny that coverage. Fortunately, you have rights, and a denial isn’t the end of the road.

I’m attorney William R. Long, and at my firm, William R. Long, Attorney at Law, I help injured or sick workers get the medical treatment and other workers’ comp benefits they deserve. I have been focusing on this area of law (and the related area of disability benefits) for more than 35 years. As a result, I know every trick in the book that employers and their insurers use to delay or deny benefits. I know how to put the right pressure on them to help you get the workers’ comp coverage and treatment you deserve.

How To Challenge Medical Treatment Denials

Maybe your initial claim for coverage was denied. Or perhaps you had been receiving coverage for years for a long-term work-related injury or illness when suddenly your coverage was discontinued. Either way, you still have the opportunity to turn your case around, provided you act quickly.

I can negotiate with your employer and the insurance company on your behalf, using strategic leverage to fight for a fair outcome. I can also help you pursue an appeal before a workers’ compensation judge as well as further appeals if needed.

When we discuss your case, I will review your situation and give you my honest guidance on the next steps and which approach is most likely to produce positive results.

FAQs: Denied Workers’ Compensation Medical Benefits

Louisiana workers who are denied medical treatment need to understand what comes next to protect their rights. Below, I address common questions that those denied the medical care they deserve after a work injury often ask.

What could cause my workers’ compensation medical treatment to be denied?

Medical treatment may be denied for several reasons. A common explanation involves claims that a treatment is not medically necessary. This often arises when the insurer believes recommended care is excessive or unsupported by documentation. A denial may also occur if the insurer attributes your condition to preexisting injuries instead of a work incident.

In some cases, the insurer may dispute the underlying claim itself, arguing that the accident did not occur at work or the injury is not covered by Louisiana law. Because these issues can be complex, employees should gather medical records, accident reports and witness statements to strengthen their position before challenging the decision.

Can workers’ compensation refuse treatment even after giving prior approval?

State law allows insurers to revisit earlier decisions, which means treatment may be denied even after it was previously approved. This often happens when a new medical opinion questions the necessity of ongoing care or the insurer believes the worker has reached maximum medical improvement.

Additionally, insurers may withdraw approval if they believe the treatment plan has changed in a way that no longer fits the original authorization. Requesting written explanations for any reversal is essential for disputing the decision through the Medical Treatment Guidelines process or filing a dispute with the Office of Workers’ Compensation.

How much time do I have to challenge a denial of my workers’ compensation medical treatment?

In Louisiana, injured workers must act promptly when disputing a denial of medical treatment. If the denial relates to a request under the Medical Treatment Guidelines, the worker or treating physician may file Form 1009 to appeal the decision. This must be done within any deadline set by the Office of Workers’ Compensation.

If the dispute involves a broader conflict about compensability or coverage, the worker may file a claim with the Office of Workers’ Compensation. Generally, this must be done within one year of the accident or within one year of the last indemnity or medical payment. Because deadlines vary depending on the type of dispute, having a lawyer review the denial letter carefully can help you comply with all filing requirements.

Let Me Help You Get The Medical Coverage You Deserve

You shouldn’t have to bear the tremendous financial burden of medical treatment for a work injury or illness. I can help you fight for the benefits you deserve. I offer free initial consultations and contingency fee representation. Call 318-562-1440 or send me an email to get started.

Based in Bossier City, I handle workers’ comp claims throughout the Shreveport-Bossier City metropolitan area of Louisiana.