Q: TX workers comp cases never close - how do you handle a denial from medicare where injury is not related?
Person on medicare had a workers comp claim and all was resolved 3 years ago. Treatment as a result of current injury to another part of body is being denied by medicare and even denied on appeal. What is needed to prove to medicare this is not a workers comp issue?
A: Have the medical provider submit the treatment through workers' compensation utilization review department for the workers' compensation carrier. The utilization departement will approve and/or deny based upon reasonable and necessary. If it is approved then see if the workers' compensation adjuster will agree to pay. If they deny the treatment because it is not reasonalby related to the work related injury, then you could use this to show medicare. You could also take it to a workers' compensation hearing and get a decision that it is not work related. The ombudsman assistence program is available for free through the Texas Department Of Insurance, Division of Workers' Compensation. With that said, I still don't know if this work because you are dealing with, well -- medicare. Good Luck.
Justia Ask a Lawyer is a forum for consumers to get answers to basic legal questions. Any information sent through Justia Ask a Lawyer is not secure and is done so on a non-confidential basis only.
The use of this website to ask questions or receive answers does not create an attorney–client relationship between you and Justia, or between you and any attorney who receives your information or responds to your questions, nor is it intended to create such a relationship. Additionally, no responses on this forum constitute legal advice, which must be tailored to the specific circumstances of each case. You should not act upon information provided in Justia Ask a Lawyer without seeking professional counsel from an attorney admitted or authorized to practice in your jurisdiction. Justia assumes no responsibility to any person who relies on information contained on or received through this site and disclaims all liability in respect to such information.
Justia cannot guarantee that the information on this website (including any legal information provided by an attorney through this service) is accurate, complete, or up-to-date. While we intend to make every attempt to keep the information on this site current, the owners of and contributors to this site make no claims, promises or guarantees about the accuracy, completeness or adequacy of the information contained in or linked to from this site.
