Workers' Compensation Medical Benefits

Workers who have suffered an on-the-job injury are entitled to receive medical care to help cure and relieve the effects of the injury. This treatment is given by "authorized treating physicians" at the expense of the workers' compensation insurance carrier.

What is often a problem for injured workers is that the authorized treating physicians are selected by the employer, not the employee. These doctors are often biased because many of them have had lasting and lucrative relationships with the employer or the insurance company and have had no long-term relationship with the worker who has been injured. Thus, pressure may be put on the physician to release the injured worker from treatment early or to find that the injured worker has no impairment.

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In a workers' compensation case, when the treating physician is more interested in pleasing the insurance company than in caring for an injured worker, it is time to contact an experienced Colorado workers' compensation attorney who can explain and protect your medical benefits' rights. At the Eley Law Firm in Denver, we have been protecting the medical benefits of Colorado workers for more than 30 years.

Who Is The ATP Or Authorized Treating Physician?

The authorized treating physician (ATP) is determined by the employer at the time the employer is told that the worker was injured. The employer usually sends the claimant to a predetermined clinic. However, if the employer fails to send the worker to a doctor, the worker can choose his own doctor. Once that choice is made, the worker must continue with the authorized treating physician or any other doctor to whom the ATP refers the worker. A worker can request a one-time change of physician within 45 days after he or she is injured.

What Happens If Medical Treatment Is Denied?

The insurance company can still deny medical treatment even if it is recommended by the ATP. It is not uncommon for an insurance company to deny authorization for treatment if an expensive procedure, such as surgery, is recommended. In these instances, the insurer will reach out to an independent medical examiner for his or her opinion. The "independence" of these doctors is sometimes questionable. Many of them do a great deal of business with insurance companies. If the insurance company's doctor does not agree with the treating physician, the matter may have to be determined by a judge.

What Is The Role Of The Nurse Case Manager?

Frequently, a nurse case manager (NCM) from the insurance carrier will accompany an injured worker on medical appointments. This gives the insurance company more direct access to the treating physician. Sometimes the nurse case managers can help coordinate treatment and help get treatment authorized. On the other hand, sometimes the nurse case manager can push doctors to release the worker early or to reduce the workers' restrictions.

The injured worker does not have to agree to have a nurse case manager. If you do not want a nurse case manager, you should tell the insurance company in writing that the nurse's services are no longer needed. You should also say in writing that you withdraw any authorization that the nurse case manager had to talk to medical providers.

Know Your Rights · 720-644-8759 · 866-371-3322 · Contact The Eley Law Firm

Call the Eley Law Firm today for a free case evaluation from an experienced workers' compensation attorney. You may also fill out the email form on the contact page, and a representative from the office will be in touch with you shortly. We look forward to hearing from you and helping with your workers' comp case.