Things the Workers’ Compensation Claims Adjuster May Not Tell You (Part 2)

In a previous article, we discussed four things workers’ compensation claims adjusters often don’t tell claimants. Because there are many things workers’ compensation claims adjusters don’t tell claimants, we decided to make a second post on “Things the worker’s compensation claims adjuster may not tell you.” In this article, we discuss four more things workers’ compensation insurance claims adjusters often fail to tell claimants in an effort to save their employers’ money.

1. You Can Self-Refer Yourself to a Healthcare Provider

The Vermont workers’ compensation system does not require a healthcare provider to refer you to another healthcare provider. You can refer yourself to another doctor, and your employer’s insurance company must cover your visits. The only requirement is that those visits must be reasonable, necessary, and related to your work injury.

2. You Don’t Need Pre-Authorization To Get Reasonable and Necessary Treatment

After an employer sustains a work-related injury, they may need authorization from their employer’s workers’ compensation insurer before they can get treatment. In Vermont, getting pre-authorization is not necessary if you are seeking reasonable and necessary treatment for a work-related injury. However, the workers’ compensation insurance claims adjuster may not tell you this.

While you don’t need pre-authorization to get reasonable and necessary treatment for a job-related injury, your doctor may decide to seek pre-authorization. Usually, doctors do this to make sure they will get paid. If your doctor decides to seek pre-authorization, they must follow a specific procedure. The most crucial thing your doctor can do if they choose to request pre-authorization is to ensure they fill out the request correctly. Vital steps for your doctor to follow to ensure this are;

• Make the request in writing
• Include medical evidence that supports the proposed treatment
• State that the treatment is necessary, reasonable, and related to your work injury.
• Provide some explanation as to why the proposed treatment is a good idea

3. You Are Not Obligated To Share Your Entire Medical File

If the insurance adjuster asks you to sign Form 7, or in other words, the medical authorization form, you must do so. Authorizing the claims adjuster to review your medical records is vital as it can help link your injury to your work. Failing to sign Form 7 can result in your claim being denied. However, you don’t have to provide your entire medical file. You are only obligated to allow the adjuster to access medical records related to your work injury.

4. You Can Decide Which Doctor Does Your Rating

Finally, the claims adjuster may not tell you that after you reach medical end result, which is the point where you’ve recovered from your injuries to a point where you can’t have any significant further improvement, you have the right to choose which doctor you want to do a medical evaluation for your impairment rating. If the insurance company tries to force you to accept a settlement based on a rating from a doctor of their choice, you have the right to get another opinion from a doctor of your choosing.

Contact a Vermont Workers’ Compensation Attorney

If you have a workers’ compensation case, contact a qualified Vermont workers’ compensation attorney at Sluka Law PLC for a free consultation.