Job Injury Talladega County Denied Medical Treatment

If you live or work in Talladega County, AL* and have suffered a serious job injury, there may come a time during the course of your medical treatment in which the treatment recommended by your authorized treating physician is denied. In our last blog on this subject, we will now discuss denial of treatment via utilization review.

Ala.Code ยง25-5-77(a) states "...the employer...shall pay [for all] reasonably necessary medical and surgical treatment and attention, physical rehabilitation, medicine, medical and surgical supplies, crutches, artificial members, and other apparatus as the result of an accident arising out or and in the course of the employment...." This section is not open to misinterpretation, it unequivocally states that the employer shall pay for all treatment which is reasonably necessary given the injured workers' condition. Given this clearly worded section, why has the difficulty in getting medical treatment approved become such a problem?

Usually, the difficulty arises when the workers' compensation insurance carrier pays a doctor, who never sees the injured worker, to render an opinion as to whether the treatment recommended by the authorized treating physician is "reasonable and necessary." Not surprisingly often the non-examining doctor, who is paid directly by the insurance carrier, decides that the recommended treatment (which can be costly) is not reasonably necessary.

The decision to deny approval recommended medical treatment is rarely upheld by a judge, as "this standard is one of reasonable necessity, not absolute or strict necessity; this standard does not necessarily limit the parties to the single 'best' treatment available. Nothing in the Act suggests that there can be only one 'reasonably necessary' approach to treating a given patient and his or her injury or illness... As a matter of statutory construction, as well as common sense, it undoubtedly is possible in many cases for more than one treatment alternative to fall within the realm of what would be 'reasonably necessary' to effectively treat a given employee." Ex parte Southeast Medical Center, 835 So.2d 1042, 1045 (Ala.Civ.App.2002). Unfortunately, the insurance carrier will stand by the decision of their hired gun until a judge orders otherwise.

If you live in the Talladega region and have suffered a job injury, but you have been told that you are not entitled to the recommended treatment, don't give up, contact Powell and Denny today.

Powell and Denny: We Work When You Can't

Offices in Birmingham, Alabama and Huntsville, AL

* includes the cities and towns of: Alpine, Bon Air, Childersburg, Gantts Quarry, Lincoln, Mignon, Munford, Oak Grove, Oxford, Sycamore, Sylacauga, Talladega, Talladega Springs, Vincent, Waldo.

Job Injury Talladega County Denied Medical Treatment