If you had a workplace injury that requires medical attention, you’ll need to see a doctor and perhaps consult a medical specialist, depending on the seriousness of the workplace injury. Selecting a doctor is a personal choice. Some employers have a preferred provider workers’ compensation insurance plan that directs where employees go for an initial evaluation of a workplace injury.
After going to your employer’s preferred provider, you have a legal right to be treated by a doctor of your own choice. Your doctor directs your care and decides when you are well enough to return to work. Still, differences can arise over the recommended treatment and costs of medical treatment. A skilled workers’ compensation attorney can help negotiate those disputes with the insurance carrier.
Injured on the Job? Contact Our Workplace Accident Lawyers
For a free case evaluation of your workers’ compensation claim, please contact us online or call us toll free at (800) 367-0871 to speak with an experienced workers’ compensation attorney at Kantrovitz & Associates, P.C. We have almost 30 years of experience fighting for the rights of individuals injured in the course of their employment.
Based in Boston, Massachusetts, the workplace injury lawyers at Kantrovitz & Associates, P.C. help injured workers across Massachusetts, including but not limited to Boston, Essex, Middlesex, Norfolk, Suffolk, Plymouth and Merrimack River. We also represent Rhode Island and New Hampshire residents whose injuries occurred in Massachusetts or who were hired in Massachusetts but who were injured out of state.
Workers’ Compensation and Medical Treatment
If your employer has a preferred provider agreement, the employer is required to provide a list of names of all approved health care providers within the geographic area after a workplace injury. Many workers mistakenly believe they can see only the employer’s designated doctor. That’s incorrect. You have to go to that doctor only for the initial evaluation of a workplace injury. You then can go to a second doctor of your own choice. If you are not satisfied with treatment provided by the second doctor and wish to see a third doctor, within that same medical specialty, the visit to the third doctor must be pre-approved by your employer’s workers’ compensation insurance provider. You are entitled to be reimbursed for all expenses related to medical treatment, including prescription medications, mileage and parking as part of workers’ compensation benefits.
Utilization Review and Workplace Injuries
Employers and their workers’ compensation claims administrators are required under Massachusetts law to have a utilization review process to monitor treatment for injured and ill employees and determine if the treatment is medically necessary. Utilization review is used to decide whether to pay for treatment recommended by your treating doctor. Insurers may conduct utilization review themselves or contract with a Massachusetts approved agent to do the review.
Massachusetts has medical treatment guidelines that provide guidance to doctors, insurers and utilization review agents about what falls within the acceptable range of treatment. Utilization review determination letters must set forth the rationale for the decision and the treatment guidelines and be sent to the injured employee and doctor in writing. If you or your doctor disagrees with the utilization review determination, you may appeal the decision. The initial appeal may be made by telephone to the utilization review agent, followed by an appeal in writing.
If your workers’ compensation claim for medical care or a medical procedure has not been approved, it may not have been submitted to the utilization review process as required or the request may have gotten stuck in negotiations over the payment. These are the most common payment problems that we see based on our experience of representing many injured workers in workers’ compensation cases.
For example, if an injured worker needs surgery for a back, neck or shoulder injury, the doctor may charge $15,000 for the procedure, but the workers’ compensation reimbursement rate may be $2,500 for the procedure. The insurance carrier may, and generally will, negotiate a payment with the doctor so the injured worker can get the treatment that they deserve. There are ways to negotiate the payment for a surgery, and a knowledgeable workers’ compensation lawyer at Kantrovitz & Associates can assist you.
Why You Need a Workers’ Compensation Attorney
The Massachusetts’ workers’ compensation system is set up to ensure that employees who are injured or disabled by workplace injuries or illnesses receive paid medical care and treatment. All employees have legal rights to workers’ compensation for work-related injuries and illnesses. And yet, employees often have trouble obtaining their rightful workers’ compensation, including medical treatment benefits. That’s where our workers’ compensation lawyers can help.
While many Massachusetts lawyers practice in a number of different areas of the law, the workplace injury lawyers at Kantrovitz & Associates, P.C., concentrate exclusively in the area of workers compensation. Our experienced workers’ compensation attorneys have almost 30 years of experience in all types of workplace injury cases — and we can help you.
We believe in a hands-on approach, providing individual attention to each and every client. We do not pass off cases to other Massachusetts law firms or to junior associates. A client will have the same attorney handling his or her claim from start to conclusion.
Our workplace accident attorneys believe strongly that all clients should be well educated with respect to the laws and should be active participants in all facets of their workers’ compensation claim. We are ready to answer workplace injury questions from workers across Massachusetts, including but not limited to Boston, Essex, Middlesex, Norfolk, Suffolk, Plymouth or Merrimack River. We also represent Rhode Island and New Hampshire residents whose injuries occurred in Massachusetts or who were hired in Massachusetts but who were injured out of state.
For a free, no obligation evaluation of your workers’ compensation claim, please contact us online. The workers’ compensation lawyers at Kantrovitz & Associates are here to help victims of workplace injuries. You may also call us toll free at (800) 367-0871.