Practical Vs. Procedural – Part I
There are two specific procedures that I find maddening and extremely difficult to explain to an often disbelieving client. The first involves an employee’s attorney need to seek a “Certification of Dispute” before actually bringing claim. Often an injured worker comes to my office with a story of their injury and how the workers compensation insurer accepted liability and paid some bills. What generally drives them to my office is a denied bill or a doctor prescribed medical procedure that the work comp insurer will not authorize.
Under the current scheme the fact that the insurer denied the procedure or bill does not really mean it is denied, denied. It means I must now petition the Department of Labor and Industry to obtain a “Certification of Dispute”. In effect it is me asking them to determine if I was correct in finding that an unpaid medical bill amounts to a dispute. This gives the insurer another chance to review it and perhaps now pay it (given that they face litigation and attorney fees) OR, and this is the frustrating one, tell the DLI that they are not really “denying the bill or procedure they are just “seeking more information” or “awaiting an opinion from their doctor”. In both instances the employee is then left hanging with no recourse to have their claim heard. It is extremely difficult to explain to a person who has received a medical bill for three consecutive months that the insurer is not really “denying” it.
Notwithstanding the impracticality of the process we, at Batchelor Law Firm, P.A., try to expedite the filing of the requests for certification and push the DLI to reply so we can then immediately file the Medical Request necessary to obtain a Hearing.