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.

Related Articles:

• What if the insurance company denies a necessary MRI or other tests?

• Can I see my own doctor for my injury?

• Do I have the right to choose my own doctor?

• What role does my medical provider play in my workers’ comp case?

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