How Will I Receive Medical Treatment if My Workers’ Comp Claim is Controverted
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When the Employer/Insurer “controverts” or determines a workers’ compensation claim is not compensable, the Employer/Insurer will not pay for the injured Employee’s medical treatment. Consequently, the injured Employee will be responsible for finding a physician to treat with and for payment of his or her medical bills. 

This determination does not necessarily mean the injured workers’ claim has ended.  It is merely the position the Employer/Insurer has taken.  It will be the claimant’s burden to prove that the Employer/Insurer is wrong. From a practical perspective, the Employee has the daunting task of locating a qualified physician to continue treatment.

When a claim is controverted, the Employee may choose to treat with a physician of his or her choice, pursuant to Board Rule 201(b).  This Board Rule  states that “the Employer/Insurer cannot restrict treatment of the Employee to the panel of physicians, conformed panel of physicians, or WC/MCO when the claim has been controverted.” Therefore, the Employee is free to choose his or her authorized treating physician.

Although an injured Employee has greater control of his or her medical treatment when a claim is controverted, the Employee is still left with the challenge of paying for medical treatment.  Since the cost for medical treatment will escalate within a short period of time, an Employee must consider alternatives to paying for medical treatment either out of pocket or through another insurance carrier.  An attractive alternative for Employees is to identify a physician who will provide medical treatment on a “lien basis”.  Treating on a lien basis means the Employee will not pay for medical treatment or services at the time the treatment is rendered, but will pay for the treatment at the time his or her claim settles.

A physician or medical facility which offers medical treatment on a lien basis to workers’ compensation patients will protect their interests by requiring that the Employee and his or her attorney sign a “letter of protection.”  A letter of protection is a contract between the patient, attorney and medical provider, which ensures the attorney will pay all medical bills for treatment rendered on a lien basis from the Employee’s settlement funds.

Seeking treatment on a lien basis is not the ideal for most Employees and attorneys, but it is a workable alternative for the injured Employee who cannot afford the immediate out-of-pocket cost.

If your workers’ compensation claim is controverted, please contact the Ramos Law Firm to discuss seeking treatment for your work injuries.