Legal Question in Workers Comp in Kansas
Refused medical treatment
I had a left knee replacement last summer. The replacement & treatment of the left knee is the result of a court order.
Today was my 6 month appointment scheduled at the request of the doctor�s nurse.
The receptionist checking me in called the case manager for authorization of today�s appointment. When she got off the phone she said the wc insurance company will not authorize for you to see the doctor for your left knee.
She then gave me a copy of a fax per her conversation with the case manager.
It reads:
Per our conversation, we are authorizing treatment of the right knee only. We are denying left knee treatment.
I read the fax and told the receptionist to look thru my medical records for the court order of medical treatment for the left knee. The office staff tells me they can not provide treatment without approval from the insurance company.
What do I need to do?
Thank you for your answer.
Kay
2 Answers from Attorneys
Re: Refused medical treatment
If you have an attorney representing you, you need to discuss it with your attorney. If you do not have an attorney, you probably need one.
You do not say whether the knee replacement is pre award or post award medical treatment. Assuming it is pre award (i.e. you have not settled or tried your case yet), then you must now file an Application for a Preliminary Hearing asking the Judge to hold a hearing and order the insurance carrier to provide further medical treatment according to your doctor's recommendation. The statute requires you make a written demand on the respondent and carrier for treatment at least 7 days before you apply for the Preliminary Hearing.
I think the Administrative Law Judge will order the carrier to pay for treatment.
Re: Refused medical treatment
It appears there is some confusion on the part of the case manager and insurance company. Your question does not indicate whether both knees are involved. If you have a lawyer, he or she should contact the other attorney or claims handler. If this is a pre-Award situation, authorization for treatment can be obtained via judge's Order at another Preliminary Hearing. If you are not represented, you should seek the assistance of an experienced workers' compensation attorney.
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