What should I do if I have a work injury?

First, tell your employer that you have a work injury.  You need to file paperwork about your injury. If you need treatment, your employer may send you to a clinic.  Be sure to fill out a claim form (DWC 1). Your employer should have this form and should give you a copy to fill out when you report your injury.  If your employer does not provide the DWC 1 claim form to you, you can go here to download the form.  

 

Can I change my doctor?

Yes, you can change your doctor.  Your employer’s workers’ compensation carrier most likely has a list of doctors (Medical Provider Network - MPN) that you can choose from.  It is within your rights to change to another doctor and to another specialty that’s appropriate on that list.

 

What is an MPN?

An MPN is a Medical Provider Network.  It is a list of doctors that the insurance carrier provides who can give treatment to you.   

 

What is the UR/IMR process?

In order for treatment to be authorized, your doctor must fill out a Request for Authorization (RFA) and send it to the workers’ compensation carrier for approval.  The carrier can approve, delay, or deny the RFA through the Utilization Review (UR) department. If the treatment is denied, delayed, or modified, the carrier sends you paperwork so you can appeal that decision.  The appeal is sent to a third doctor, an Independent Medical Reviewer (IMR). The IMR doctor reviews the decision and can Overturn (approve) or Uphold (denied). The IMR decision is good for one year unless circumstances have changed.

 

Can I go back to work?

Yes, you can go back to work as long as the work you will be doing is within your doctor’s restrictions.  You do not want to re-injure yourself or make your injury worse by doing more than your doctor has advised.  

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They say my case is denied, what can I do?

If your case is denied by the workers' comp carrier, you will likely receive a form for a Qualified Medical Evaluation.  If you have questions about the QME process, we suggest you speak to a workers' comp attorney about it.  There are steps to get your claim accepted, but it is likely you may have to litigate (or go to court) to do that.

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