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Workers' Comp and the Rules with Medical Treatment

Author: Portner & Shure

Since the Workers’ Compensation carrier has been paying for your medical treatment, when your doctor has referred you to another doctor or for additional testing such as an MRI, you may think you should just be able to make the appointment and go.

That isn’t always the case. While there is usually a seamless transition to the new doctor or for the test, the evaluation or the test must be approved by the Workers’ Compensation carrier’s adjuster. The adjuster has to tell the new doctor, or testing facility, that the comp carrier will guarantee payment of that visit.

Often times this may take a day or two because your doctor’s office has to get that referral and supporting records to the adjuster and the adjuster has to give authorization to the new provider. The new provider may opt not to make the appointment and put it on the doctor’s schedule until they have received this approval.

The Maryland Workers’ Compensation statute provides that the Worker’s Compensation carrier may challenge whether the additional evaluation or testing is necessary.

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