Preauthorization usually becomes an issue when you need surgery because a doctor will not perform surgery if someone doesn’t promise to pay the bill. And if you can’t get the insurance company to preauthorize the surgery, you’re stuck. You can’t work without the surgery and you can’t get the surgery.
Insurance companies will sometimes say that they are under no duty to preauthorize medical treatment. That’s not true. In Alaska workers compensation cases, the insurance company has a duty pay all reasonable and necessary medical treatment which is caused by the work-related injury. If they don’t want to pay the bill, the insurance company must justify its refusal.
The right way for the insurance company to do that is to controvert the recommended surgery based upon an EIME report. Sometimes the insurance company will stall preauthorization while it sends the injured employee to an EIME (Employer “Independent” Medical Evaluation) to see if the doctor of their choosing agrees that you need surgery and the recommended surgery was caused by the work injury. When the insurance company controverts, it should send you a Controversion Notice.
But sometimes the insurance company will just blow you off. That is called “controversion-in-fact.”
In each of these cases, there is something you can do. You can file a claim for medical benefits including obtaining a Board order authorizing the surgery. The claim must be filed with the Workers Compensation Division. http://labor.state.ak.us/wc/home.htm.
If the insurance company is refusing to preauthorize your surgery, you need to find out whether you are being treated fairly. Call an experienced Workers Compensation attorney.
Keenan Powell has practiced Workers Compensation law in the State of Alaska for over 30 years and has dedicated her practice to Workers Compensation representing injured Alaskans handling hundreds of cases. www.keenanpowell.com.
All consultations are free. To make an appointment, use the contact form on this website or call: 907 258 7663.