If you have been injured in the workplace and are awaiting a final decision from a workers’ compensation claims administrator, you probably know that every day counts. The sooner you begin your medical treatment, the sooner you will be able to recover and return to work.
And while you are waiting for the workers’ comp claims administrator to authorize or deny your treatment, you are probably wondering, “How long will you have to wait?” the workplace injuries lawyer in Los Angeles from the Koszdin, Fields, Sherry & Katz law firm to answer this question.
Why do you have to wait for the claims administrator’s decision?
If you agree with your primary treating physician about the necessary medical treatment and the claims administrator has been notified about the treatment, you will have to wait for the claims administrator’s decision before beginning the treatment in order to make sure that your employer will pay for your medical expenses and other damages and losses suffered as a result of your on-the-job injury.
By beginning a medical treatment your employer has not authorized yet, you risk losing your right to receive workers’ compensation benefits. So you will have to wait for the claims administrator’s decision.
Who can change or deny your medical treatment?
In its decision based on utilization review (UR), a claims administrator is permitted to approve treatment but is not permitted to alter or deny treatment without consulting with a “physician reviewer.” In the UR process, a competent physician who is qualified to evaluate medical treatment is permitted to change or deny treatments.
The claims administrator will merely notify you and your primary treating physician if a physician reviewer chooses to alter or deny treatment. How soon you can expect the claims administrator to issue his or her final decision depends on whether your medical condition is “urgent” or not.