WHY DOES TREATMENT TAKE SO LONG TO GET AUTHORIZED?
Treatment through workers' comp has to get authorized by the insurance company before an injured worker can get the medication/treatment.
1. Your treating doctor wants to get you treatment - that doctor has to fill out an RFA (Request for Authorization) and send it to the claims adjuster.
2. The insurance company reviews the treatment (Utilization Review - the second doctor) and can approve, deny, or delay their decision.
The injured worker or doctor can file for an appeal for a denial or delay.
If you're signed up with our office, our office automatically appeals every denial or delay from the insurance company.
3. When we appeal, the treatment decision gets reviewed by an Independent Medical Reviewer (IMR - the third doctor). The IMR decision is good for one year unless there's a change of circumstances (injured worker is getting worse, etc.).
That whole process can take over a month before there's a final decision whether an injured worker gets the treatment.
This is the procedure that was created by the state legislature.
If you need help getting medications/treatment approved, you can contact our office by phone (831) 753-9127 to find out if we can help your workers comp case.