Not uncommonly, a claims adjustor may deny medical treatment because they don’t understand the nature of the claim. For example, if you have an injury and the treating doctor wants surgery, he or she may order certain tests before surgery. Test such as a complete blood count (CBC) or ECG (electrocardiogram) are not unusual. Claims adjustors may deny the tests just because they don’t understand why they are being ordered. Usually, a call to the claims adjustor can resolve the issue.
Somewhat more problematic is the situation in which the insurance company second guesses the treating physician by hiring a second doctor to give an opinion.
These doctors tend to be nameless and faceless. They are doctors who have never seen the patient and are doing a review based on the medical records not on the medical condition of the patient.
For example, the treating physician may prescribe a home traction unit. The insurance company gets their own doctor ,whose speciality is saying no, to look at the records and state the treatment isn’t necessary.
There is a solution to this problem. In Missouri, a hardship mediation can be requested. The attorney will need to file a claim and get the medical records to support the additional medical treatment.
If you have been injured on the job and denied medical treatment, please call: Margaret E. Dean, Attorney at Law, 816-753-3100.
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