How Long Does Workers’ Compensation Pre-Authorization Take?
Being injured at work can be overwhelming, especially when the injury is so severe that it puts your health and income at risk. When one is injured at work, prompt medical care is crucial, and the last thing they want is for a healthcare provider to require pre-approval for medical care. Injured workers in Vermont can sometimes wait weeks while their doctor receives pre-authorization for specific treatment. This can result in unnecessary delayed recovery because Vermont doesn’t require pre-authorization in worker’s comp claims. However, if your healthcare provider needs to ensure they will get paid and therefore need pre-authorization, you may wonder how long it takes. Read on to find out more.
What Is Pre-Authorization?
Pre-authorization or pre-approval occurs when medical providers decline to proceed with treatment for a patient until they get an assurance from the workers’ comp insurance company that they will be paid for their services. In Vermont, pre-authorization is not required, but if your medical provider insists on having it because they need to be sure that they will be paid, they must provide it in writing and include relevant medical evidence. After the insurance company gets the request, they must respond within 14 days to the request for pre-authorization. The response can:
- Authorize the treatment
- Deny the treatment if the claim was denied or if the preponderance of evidence shows it is unnecessary or unreasonable
- Schedule an Independent Medical Examination (IME) or records review for the claimant and give a response within 45 days of receiving the request.
Steps To Ensure Pre-Authorization Is Successful
If your doctor requests pre-approval for their peace of mind about payment, it is vital to ensure that the request is done correctly to avoid denial. Here’s what your medical provider needs to do to ensure a successful request:
- Submit the request in writing: Ensure your medical provider submits the pre-authorization request in writing
- Provide medical evidence to back up the proposed treatment, such as medical notes, a referral from the doctor for the medical procedure or diagnostic test
- Clearly state in writing that the treatment is reasonable, necessary, and directly related to the work injury
- Offer a solid explanation about why the proposed treatment is appropriate and beneficial
What Happens if the Insurance Company Does Not Respond?
If the workers’ compensation insurance company doesn’t respond to a preauthorization request within 14 days, you or your healthcare provider can ask the Department of Labor to issue an Order authorizing the treatment. If the insurance company denies the request, you can still seek an Order from the Department of Labor by presenting evidence that the treatment is reasonable, necessary, and directly related to the work injury. An experienced workers’ compensation attorney can assist you in getting the Department of Labor (DOL) to require the insurance company to approve the treatment, as long as your doctor followed the proper steps for the preauthorization request and the treatment is deemed reasonable and necessary.
Contact a Vermont Workplace Injury Lawyer Today
If you have suffered an injury at work, consult an experienced Vermont workplace injury lawyer at Sluka Law PLC at 802-457-1000 today to guide you through your workers’ comp claim and secure the compensation you deserve.
Source:
legislature.vermont.gov/statutes/section/21/009/00640b
