REDULA & REDULA LLP

Treatment through workers' comp has to get authorized by the insurance company before an injured worker can get the medication/treatment.  

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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.  

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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.).  

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That whole process can take over a month before there's a final decision whether an injured worker gets the treatment.  

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This is the procedure that was created by the state legislature.

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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.