Emergency Medical Treatment Does Not Need To Be Authorized

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If you don’t obtain prior approval for emergency treatment, you can still file a workers’ comp claim.

Today’s post is by my colleague Matthew Funk of New York.

When an injured worker needs emergency medical care, prior authorization isn’t always possible and obtaining it does not bar a workers’ compensation claim. When a worker is hurt at work and is rushed to the emergency room for treatment, there often isn’t enough time to seek authorization from an insurance company and to obtain a claim number.

At the time of the treatment, if possible, the injured worker should let the hospital and medical provider know that the injury occurred at work and the exact details of all his or her injuries. This is sometimes an effort since emergency staff are rushed and understaffed. After the emergency care is provided the worker should immediately seek the guidance of an attorney to assist in filing a claim and obtaining reimbursement for the medical care.

At the time of the treatment, if possible, the injured worker should let the hospital and medical provider know that the injury occurred at work and the exact details of all his or her injuries.

The law provides that the cost of the emergency medical treatment will be adjusted to meet workers’ compensation payment guidelines. Many times doctors submit bills to the private carrier with a note stating, “Do not pay, submitted pending determination at the Workers Compensation Board”. This ensures that if the Workers Compensation claim is not successful, the doctor can still be paid.

The employee should save all copies of all notes, receipts, and diagnostic reports that the treating physician has available and to keep a diary. The easiest way to keep a diary to use a calendar and mark on it all treatment appointments, procedures, tests, medications and complaints. Make a copy for your lawyer also.

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