Legal Question in Workers Comp in California
Ihadanaccident at work two years ago, the insurance does not want to autorize the procedure to relive the pain that I have, can I go to the emergency room for help?
4 Answers from Attorneys
If you need to go to an emergency room, then go. Be sure to tell them that your injury stemmed from your employment.
The ER will be billing you, but be sure to send the bills to the defense.
Please feel free to contact me on my cell phone tomorrow morning for a free consultation. It's best to contact me around 3:00 PM. My number is 818.943.0462.
Sounds like you need an attorney at this point. Please feel free to call me 949-830-1182.
You need an experienced attorney to send you to a worker's compensation doctor for your ongoing treatment. A worker's compensation will bill the insurance company directly. Feel free to call us at 213.388.7070 for a free consultation.
YES, TRY TO USE THE EMERGENCY ROOm BUT make absolutely clear this is an industrial injury, a workers comp action.
take all your insurance details: phone, fax, claim number, address of insurer, adjuster's email, adjuster's favorite colors, ... every detail so the ER Clerk can phone and fax the adjuster with an insurance company claim number and a demand to ok the treatment.
WHEN YOU GET REJECTED save this and take it to you physician so the physician can document you are attempting to get the recommended treatment.
THEN HELP YOUR DOCTOR appeal the Non-Certification. The letter refusing to certify the doc's written "Request For Authorization" has an appeal process right in the letter... tells you who to appeal to and when (typically by fax, you appeal and the doc appeals ASAP).
Sometimes the Utilization REview denial tells the Treating Doc WHY the procedure was non-certified. SHOW THIS TO TO DOC. If the doc fixes the missing detail in the appeal and the new Request For Authorization, sometimes the reviewer gets tired and authorizes it
CERTIFIED SPECIALIST ATTORNEYS know the details of this review process and will fax the appeal the date the non-certification is faxed to them... start looking for a Workers Compensation Certified Specialist to represent you (they cost exactly the same as general practitioners who send you to a chiropracter, but you get a real specialist referring you to real doctors instead).
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