Q: If workers comp denied a body part several times but later authorized treatment, what can I do?
I was injured on the job by a co-worker. Several body parts were said to be not compensable by workers comp. After being denied many times for treatment and a change of adjuster, my treatment was approved. I have had 3 MMI’s. Can you please tell me what steps should I take to discuss Why I was denied treatment earlier.
A: Its complicated b/c a carrier (IC) may dispute an injury as not being "in course and scope". Once that issue is settled as a compensable, the IC can still dispute that medical treatment was not reasonable or necessary. I know of cases where there was a preauthorization and latter a denial. Make sure you have all compensable injuries clearly defined so extent of injuries are more difficult.
Sorry, discussing the denial will be futile b/c the Texas Supreme Court (TSC) decided to usurp legislative power and write a law. The TSC abolished workers comp. "bad faith" claims against IC even though the legislature had previously denied awards greater than $250,000 by statute. The TSC is required to "interpret" laws so as to give full meaning to laws passed by Congress. By ruling there is no bad faith, the TSC made the LAWs properly passed pertaining to bad faith, moot or meaningless.
I am sorry in my opinion that is a bad decision.
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