Posted by: Martha Ramsay on Aug 2, 2017

Contributed by Ramsay Law Firm, P.A

Do you know how to schedule an appointment for a denied W.C. condition?

Imagine the situation – you’ve injured your foot and the defendants have agreed it’s a compensable claim, but your foot gives out and you fall and injure your knee. The W.C. carrier is refusing medical treatment for your knee and the burden of proof lays with you to prove that the knee is related to your foot injury.  Your knee claim is considered denied.  How do you go about getting a doctors’ appointment in this situation?

Your attorney’s office can call and schedule a doctor’s appointment for you but the difficulty is that the doctor’s office flips to the attorney rates for scheduling such an appointment, which can be $1,000-1,500 for the appointment. As this expense is deducted out of any final settlement in your case, this is clearly not the best way to proceed in your claim.

The better way to proceed in your claim is for you to call the doctor’s office directly and to tell them that you are self-pay or you are using insurance (if you have any available), for your condition. You don’t need to tell them it is a w.c. injury when scheduling the appointment.  You simply need to describe your symptoms and the fact that you need medical care. If it comes up that it is a w.c. injury, you would explain to them that you believe it is related but the w.c. carrier has denied it and they are not going to authorize any medical treatment; therefore, you are being forced to seek medical treatment on your own and you are responsible for payment.

Of course, when you talk to your physician during your initial evaluation, you will describe to them how you got injured, how long your symptoms have been going on, and what you believe is the cause of your symptoms.  You will ask the physician to diagnose your condition, to recommend treatment and to let you know whether he thinks it’s related back to your w.c. injury.

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