Denial of
Medical Treatment
Fighting for the treatment you deserve.
The Law Office of Alice A. Strombom helps workers in Sacramento through the workers’ compensation claim process. While every claim follows a standard path, there’s always a situation where your medical treatment costs might be denied. It’s frustrating, but it’s not the end of the story. Our team can make sure you get the benefits you need to get better. Start today with a free consultation.
How Can We Help You If Your Medical Treatment is Denied?
- Reviewing why your treatment was denied. If it’s missing paperwork, a dispute over your injury, or an insurance decision, we figure out why this happened.
- Getting ready for an IMR. This gives you a second opinion from an unbiased doctor who isn’t tied to the insurance company.
- Guiding you through your appeal. From paperwork to hearings, we handle the legal steps while you focus on healing.
- Protecting your rights. Insurance companies don’t get the final word. We make sure you get the treatment you need.
Why Would Your Workers’ Comp Medical Treatment Be Denied?
Getting medical care after a workplace injury should be straightforward—but unfortunately, it doesn’t always go that way. In some cases, your employer’s workers’ comp insurance may deny treatment that your doctor recommends. This can feel like a slap in the face when you’re just trying to heal and get back on your feet. Here are some of the most common reasons this happens:
- Not enough medical evidence – If there’s not a clear medical link between your injury and your job duties, the insurance company might deny treatment.
- You missed the deadline – In California, you generally have 30 days to report a work-related injury. Miss that window, and the carrier might claim your injury didn’t happen on the job.
- They blame a pre-existing condition – If you have a medical history involving similar injuries, the carrier might try to shift the blame and deny your treatment.
- You didn’t follow the treatment plan – Skipping appointments or not sticking to your doctor’s instructions can be used as a reason to cut off your care.
- You saw the wrong doctor – In California, workers’ comp typically requires you to see a doctor in the insurance company’s network. Going outside that list without prior approval may mean a denial.
- They question your claim – If the insurance company suspects your injury isn’t as serious as reported–or doesn’t believe it happened at work–they may deny your care outright.
- The treatment isn’t “necessary” – Some procedures, medications, or therapies may be labeled as not medically necessary based on guidelines set by the insurer.
- Gaps in care – If you wait too long to seek treatment after your injury, they may claim the condition isn’t related to work.
- Missing or incomplete paperwork – In some cases, your treatment might be denied simply because the required forms weren’t filed correctly.
- Employer disputes the claim – If your employer says the injury didn’t happen at work or disputes the circumstances, that can delay or block treatment approval until the issue is resolved.
Obviously, there’s a lot of different reasons why your medical treatment could be denied by your employer’s workers’ compensation insurance company. Often, the number one priority of these companies is to preserve their bottom line by paying out as little as possible. But remember, you have options.
What Can I Do If My Workers’ Comp Treatment Is Denied?
Even though it’s frustrating, it’s important to remember that a denial of medical treatment isn’t the end of the road–and you aren’t being left hanging. You have options, but it’s all about taking the right steps and responding appropriately once your initial treatment is denied. Here’s what you can do:
- Ask for an Independent Medical Review (IMR) – If your treatment is denied by the insurance company’s utilization review (UR), you have 30 days to request an IMR. In this process, an independent doctor–who isn’t affiliated with your employer or the insurance company–will review your records and decide if the treatment is medically necessary.
- Appeal to the Workers’ Compensation Appeals Board (WCAB) – If the IMR result still doesn’t go your way, you can take the issue to the WCAB. You’ll need to file the right paperwork and prepare for a possible hearing.
- Attend a hearing with a judge – At the hearing, a workers’ compensation judge will hear both sides–yours and the insurance company’s–and decide whether your treatment should be approved. You’ll be able to present evidence, medical records, and any expert opinions to support your case.
- File for Reconsideration – If you disagree with the judge’s ruling, you can file a Petition for Reconsideration. This asks the WCAB to take another look at your case. If necessary, further appeals can even reach higher courts–but at that point, it’s often time to talk about other options.
Denials are frustrating, especially when you’re still recovering. Our team understands how the workers’ comp system works–and we’re here to step in, deal with the paperwork, and help you move forward with your medical care.
Get Help After a Denial of Medical Treatment in Sacramento
When you’re hurt on the job, getting medical care shouldn’t be a battle—but sometimes it is. If your treatment has been denied under workers’ comp, you’re not out of options. At The Law Office of Alice A. Strombom, we help injured workers in Sacramento push back and move forward.
If your treatment has been denied, let us help you challenge the decision and get back on track. Reach out today for a free consultation. We’ll explain your next steps, starting with a clear plan to get you the care you need.
