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New Law Accelerates Medical Treatment for Injured Workers

Pre-authorization law accelerates medical treatment for injured workersUnder a new Vermont law, injured workers with an accepted workers’ compensation claim can now get quick pre-approval for necessary medical procedures. Workers’ compensation insurers must now respond to a request for medical pre-authorization from a medical provider within 14 days, as long as the claim has been accepted and medical records support the request. In the past, insurers had no obligation to pre-approve any medical procedure or treatment for injured workers in Vermont. Often, the injured worker was unable to get necessary medical help because the insurance company simply ignored requests for authorization, and medical providers could not move forward with treatment options without a guarantee of payment. As a result, many people were unable to have necessary surgery, physical therapy, or medication to treat their injuries. That is now changed. Once a request for pre-authorization is made, the insurance adjuster must do one of several things:
  • approve the request and authorize the treatment
  • deny the request if the underlying claim was denied
  • deny the request if the proposed treatment is unreasonable or unnecessary, or
  • schedule an independent medical exam with another doctor and submit the report within 45 days of the initial request for treatment.
In short, the insurer must take action and must support any denial of the proposed treatment with solid legal or medical evidence. If the insurer fails to respond within 14 days of the request, the injured worker can seek an order from the Department of Labor requiring the insurance carrier to pay for the treatment. This is good news for injured workers and their families. Now necessary medical treatment can be delivered in an expeditious manner, helping workers recover faster and get back to work sooner.

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