Virginia Employees’ Rights When Denied Treatment for Workplace Injuries

One of the key benefits under Virginia’s workers’ compensation system is that eligible employees can receive lifetime medical care for a workplace injury or occupational disease. When you are hurt or discover a work-related ailment, you file a claim with your employer’s workers’ comp insurance company to obtain these benefits. However, under some circumstances, the insurer may deny your request for treatment or a procedure, even when your doctor recommends it. Alternatively, you may have already received essential care, but the insurance company refuses to pay for it. 

If you find yourself in such a situation, you do have options that enable you to go forward with treatment. While you should always trust a Virginia workers’ compensation lawyer for legal help with the specifics, you may benefit from reviewing some general information about your claim. 

Decisions Regarding Surgery or Treatment for Work Injury

Because most Virginia employers are required to carry workers’ comp insurance to protect injured employees, it is the insurer that makes decisions regarding your medical treatment. Even if you were approved for initial care, the insurance company may deny further treatment or surgery – despite the fact that you enjoy lifetime medical benefits.

When the workers’ comp insurance company intends to reject a claim, the scenario is familiar:

• Your treating physician makes a recommendation regarding a procedure, medication, or other treatment;
• The insurance company receives the recommendation, but the claims adjuster disagrees – at times after consulting with the insurer’s own medical professionals;
• The claims adjuster says that a second opinion is necessary from a third-party, allegedly neutral physician, known as an independent medical examination (IME);
• The physician who conducted the IME states that further treatment is not necessary or not related to your injury, providing the insurer with grounds to deny your claim.

Reasons Workers’ Comp Insurers Deny Treatment

There are multiple reasons the insurance company might reject your request for further treatment, and some are justified. When the denial is wrongful, the grounds are typically financial, since the insurer is trying to protect its own bottom line. Some of the reasons the insurance company will employ to support a denial of further treatment include:

• You were not hurt badly, which is a concern when you have suffered soft tissue injuries;
• You exacerbated your injuries by not following your doctor’s care instructions;
• You did not comply with Virginia workers’ comp laws regarding filing deadlines;
• Your injuries are not work-related;
• The second opinion from the IME physician states that you have reached maximum medical improvement (MME), and no additional treatment will improve your condition;

Discuss Your Rights with a Virginia Workers’ Compensation Attorney 

While this information may help you understand the basics, it is important to work with experienced legal counsel if your request for further medical treatment was denied. There are ways to fight back to obtain coverage for medical care, and you are in a better position to do so when you have a Virginia workers’ compensation attorney on your side. To learn more about your rights, please call Hampton Injury Law PLC today to schedule a no-cost case evaluation.