In a workers’ compensation claim, all benefits must be based on allowed conditions in the claim. Allowed conditions are the list of conditions the Bureau of Workers' Compensation (BWC) accepts as being caused by the specific work-related injury. If a doctor files a request for specific medical treatment, the treatment may only be approved if it is medically reasonable and necessary for the allowed conditions.  

Treatment aimed at non-allowed conditions will be denied. Especially in the early stages of a claim, doctors may move more quickly in requesting treatment than in requesting new conditions. This can lead to denials of treatment as the allowed conditions formally recognized as part of the claim do not justify the treatment requested. This problem can be solved by securing the necessary medical evidence to support new conditions. A motion can then be filed with the BWC seeking to add these conditions to the claim. Once added to the claim, the doctor’s request for further treatment may have a better chance of being approved.

At other times, the workers’ compensation system may question whether the treatment is medically necessary. Even in established claims, treatment can be denied if the BWC believes the treatment is no longer medically necessary. In these situations, a hearing before the Industrial Commission to resolve the dispute will likely be necessary.

The denial of treatment can be a frustrating development in a workers’ compensation claim.  At Herdman Yeager, LLC, we will work with your doctor to secure medical evidence to support further conditions in the claim and to support the underlying need for the treatment. If you are being denied treatment under your claim, please contact us for a free consultation to discuss your situation.

Christopher Yeager, Esq.

Disclaimer: This blog provides general information on legal issues and is not a substitute for legal advice. Each individual claim is unique. To seek legal guidance, you should contact an attorney.