My Doctor Has Requested Certain Tests Or Procedures And I Am Waiting For Authorization. What Do I Do?

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If your doctor is requesting authorization for treatment for your knee, shoulder, neck, or back, the doctor must refer to the new Medical Treatment Guidelines that became effective on 12/1/10 to determine whether the treatment is within the guidelines and if the procedure or medical care is considered authorized without prior approval. If the procedure or treatment is beyond the guidelines, the doctor must complete the appropriate forms to request authorization.

If your doctor is requesting authorization for medical attention for sites other than your knee, shoulder, neck, and back that costs less than $1,000.00, there is no need to obtain authorization from the carrier. If the medical requirement or test costs more than $1,000.00, they must submit the appropriate request form. The carrier has thirty days to answer the doctor’s request for authorization and either deny the request or approve it.

All of the authorization request forms are detailed and require accurate and thorough completion in order to be considered by the Workers Comp Board. They must be sent directly to the carrier, the Workers’ Comp Board, and the Claimant’s attorney. If the carrier has not responded timely, there are procedures to have the Board authorize the treatment. If the carrier denies medical care, litigation may be required.

Terry Katz, Esq.

Founder of Terry Katz & Associates, a Long Island law firm specializing in workers’ compensation and social security disability for over twenty-five years.

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