If the insurance company denies you an MRI, a test, or any treatment, what we do is file a petition in the Workers’ Compensation Court saying that you needed this form of treatment, it was denied or not approved, and we ask for a court order authorizing and approving the treatment or test you require. Once we get that order, the insurance company must pay it because a judge has weighed in on the dispute and determined the treatment is reasonable and necessary. If you need help navigating a denial, our workers compensation lawyers in Rhode Island can guide you through the process, and you can also review our denied claim appeal in RI for a better understanding of how treatment approvals work. It may also be helpful to explore issues like doctor-recommended treatment denials or your rights when choosing your own doctor.

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You can, and quite often your primary care provider is the quarterback of your care with respect to your work-related injury. But if your injury requires specialized treatment—whether from an orthopedic surgeon, neurologist, or another specialist—you are still entitled to any care that is reasonable, necessary, and related to your work injury, and the workers’ compensation insurance company must approve and pay for it. If they deny the referral or treatment, we know how to take action on your behalf and how quickly we can get it resolved. For further clarity on your medical rights, you can review our Rhode Island workers’ compensation lawyers resource or visit the RI workers’ comp benefits. You may also want to explore related topics like what happens when treatment is denied or how medical providers influence your case.

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If you find yourself in a situation where your doctor is saying you need surgery, an injection, or some type of treatment or diagnostic study and the insurance company denies it, it’s certainly not a fun situation to be in—but the real question is, what do you do about it? If that happens and we represent you, we first make sure that the request for the treatment, referral, or procedure your doctor is recommending is in writing. We ensure we can show it was demanded in writing to the insurance company, and then that the requisite period of time in Rhode Island—21 days—has passed.

If the insurance company denies it—or, more commonly, simply doesn’t respond—we don’t waste any time. We file a petition in the Workers’ Compensation Court stating that your doctor has recommended this treatment and the insurance company has not approved it within the 21-day period. When we go to court, the judge reviews the evidence and determines whether the treatment is reasonable and necessary for your work-related injuries. This is something that happens every day in the Rhode Island Workers’ Compensation Court, and we are there every week enforcing our clients’ right to treatment their doctor says is necessary. For more guidance, you can explore our workman’s compensation lawyers resource or review the RI workers’ comp benefits to understand how treatment approvals work. Related topics like MRI and test denials or the role of your medical provider’s opinion may also be helpful.

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• What should I do if the insurance company pressures me to return to work?

You do under the Workers’ Compensation Act. If you’re injured at work and entitled to workers’ compensation benefits, then you’re entitled to choose the doctor who treats you and helps you recover. This is usually a decision made at the beginning of your case. From time to time, the doctor you choose may decide you need to see a specialist—an orthopedic surgeon, neurologist, or another provider—and you’re entitled to that referral as long as the treatment is reasonable and necessary. You do not have to let anyone else pick your doctor for you, especially not the insurance company. For more clarity on your medical rights, you can review our Rhode Island workers compensation attorney resource or visit the RI workers’ comp benefits. You may also want to explore related topics like what happens when treatment is denied or how medical evidence shapes your case.

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If you’re feeling pressure from the insurance company or anyone to return to work, you should talk to your lawyer and determine whether it’s reasonable to try returning at that time or whether it’s unreasonable because you’re still not better. The purpose of the workers’ compensation system is to support you while you are unable to work, for as long as that may be. Pressure from adjusters does occur—often when unrepresented workers speak directly with insurance personnel who may make comments to make the injured worker feel guilty or rushed into going back so the insurer can close out the claim.

Pressure to return doesn’t help anyone. The system already has built-in incentives to get you back to work when appropriate, but no one should be pushing you before you’re medically ready. Most people don’t enjoy being out of work and are earning far less than usual, and the emotional toll can be significant. It shouldn’t be made worse by an adjuster urging you to go back prematurely. If this is happening, you may want to consider why you’re talking to the adjuster at all. Communication should go through your lawyer—someone with your interests in mind—not the insurance company. For additional guidance, you can review our Rhode Island workers comp attorney resource or visit the RI workers’ comp benefits to understand your rights in these situations. You may also want to read related issues such as treatment denials or how to handle doctor choice disputes.

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• Do I have a right to my own medical care, or can the insurance company decide?

Yes, they can. And I don’t mean yes they can in the sense that they can pick what doctor is your treating doctor—the doctor whose job it is, like any doctor you normally see, to get you better. What I mean is that if the insurance company sends you a notice that they want you examined by a doctor they’ve chosen, hired, and paid for, you do have to attend that examination.

But they cannot decide who your treating doctor is. You can continue treating with your own doctor, and you remain entitled to receive reasonable and necessary medical care for your injury. The insurance company simply has the right to have you examined from time to time, at reasonable intervals, by a doctor of their choosing. It’s also important to understand that this is not your doctor—there is no physician-patient relationship. They are not there to treat you or get you better, and you cannot bring a malpractice claim against them if they give an incorrect opinion to the insurance company. For more clarity on your rights in these situations, you can review our workers comp lawyer in Rhode Island resource or the RI workers’ comp benefits. You can also explore related issues like treatment denials or the role of your medical provider’s opinion.

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You certainly have rights with respect to who you see as your doctor for your work-related injury. You have the right to choose your physician in the first instance, and the insurance company cannot dictate that for you. Sometimes insurance companies or employers have a policy or relationship with a particular medical facility and may encourage injured workers to go there—but you don’t have to. You have the right to select your own physician, though you may need someone to enforce those rights and assert that you are entitled to your own doctor.

The only exception is that the insurance company does have the right to send you for a one-time examination by a doctor of their choosing. This is often called an “independent” medical examination or IME, although there is nothing truly independent about it—the insurance company hires and pays that doctor. These exams can sometimes lead to opinions that support the insurer rather than you. You must attend these examinations, and I always tell clients to be cooperative, but you should also speak with your lawyer before and after the IME. These exams often forecast what the insurance company may attempt next—such as stopping your benefits, denying treatment, or challenging your disability status.

You also have rights regarding what happens after the IME. Under the Workers’ Compensation Act, you are entitled to a full copy of the IME doctor’s report once the insurance company receives it, though unrepresented workers often don’t get it promptly. You’re also entitled to reimbursement for mileage to and from these appointments. These rights are spelled out in the law, but injured workers often don’t know how to enforce them. For additional guidance, you can review our workers compensation lawyers in Rhode Island resource or visit the RI workers’ comp benefits to better understand your medical rights. You may also find it helpful to read more about insurance-ordered exams or how medical evidence influences your case.

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Can they stop your benefits for any reason is a bit of a difficult question to answer, because in one sense yes—sometimes they just do it, and even though they’re not supposed to, it could be a mistake or, in some cases, intentional. We don’t always know. But if you hired a lawyer and you were put on workers’ compensation benefits the right way and are legally entitled to those weekly checks, then theoretically they cannot stop them without court intervention or without your agreement. You are protected, which means that if they do stop your benefits improperly, there are legal consequences, and your lawyer can enforce your rights.

For example, if they stop paying you for any period of time, you’re entitled not only to the missed payments but potentially a penalty on top of them. Unfortunately, it’s not uncommon to see cases where benefits stop for no clear reason—but legally, they cannot do that, and we can take the matter to court, get your benefits reinstated retroactively, and seek penalties and attorney’s fees. Ideally, the insurance company pays what they’re supposed to when they’re supposed to, but in reality, that doesn’t always happen. This is why having an attorney ready to act quickly can make all the difference. To understand more about how benefit issues are handled, you can review our workman’s compensation attorneys resource or visit the RI workers’ comp benefits. You may also want to read about related issues like insurance-ordered doctor exams or how medical opinions influence your case.

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• What’s the role of the insurance adjuster in my claim?

The insurance adjuster is the single person typically assigned to your case, and their job is to make sure you’re getting everything you’re entitled to under the Workers’ Compensation Act. That’s the ideal. But adjusters also work for a for-profit insurance company, which means that when something is a close call regarding your entitlement, there is often explicit or implicit pressure to make decisions that benefit the insurance company financially rather than you. So, there are two sides to it: many adjusters do a good job handling claims, but ultimately, they serve their employer—the insurance company—and that can sometimes mean delays or denials that prevent you from receiving what you deserve as promptly as you should.

This is why you should always have someone on your side watching over your claim—your lawyer. While an insurance adjuster is working in the insurance company’s best interest, your lawyer is focused on protecting yours. For additional clarity on how these situations unfold, you can review our workers compensation lawyers in Rhode Island resource or visit the RI workers’ comp benefits. You may also find it helpful to explore related issues such as insurance-ordered medical exams or benefit interruptions.

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If you feel retaliated against after filing or pursuing workers’ compensation benefits, your first step should be to contact your lawyer—and if you don’t have one, you should get one immediately. An experienced attorney can guide you through the situation and help determine whether the behavior you’re experiencing qualifies as unlawful retaliation. Our workers compensation lawyers in Rhode Island can assist with evaluating the circumstances and advising you on the safest way to respond.

Your next steps will depend heavily on the type of retaliation. In many cases, your workers’ comp lawyer can address the issue directly or take action to protect your rights. You can also review our denied claim appeal in RI for broader guidance on navigating disputes and protecting yourself during a claim. Sometimes, issues that look like retaliation overlap with concerns such as whether your employer may judge you for filing or even whether an employer can fire you for filing a claim, which makes early legal guidance even more important. In some cases, retaliation may fall outside workers’ compensation law altogether, such as discrimination or harassment, and your attorney can connect you with the right professional to handle those matters.

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