It is frustrating and stressful when an insurer wrongfully denies workers’ compensation coverage for specific medical treatments. Unfortunately, this occurs far too often throughout Louisiana, including instances where a doctor recommends a procedure/treatment as reasonable and necessary. It is important to know that help is available, and that you still might be able to receive the money you need with legal representation.
At DeJean & Leger, located in Opelousas, we have more than 55 years of combined experience resolving even the most complex workers’ compensation issues. Please speak with us today if you believe an insurance company or adjuster is wrongfully denying coverage. We are also able to help if your coverage has been terminated or is facing termination. We will work quickly to ensure you receive payment for the medical treatment you need.
Feel free to schedule your free initial consultation by contacting our St. Landry Parish law office online today. You may also call our firm directly at 337-948-9066 to learn more about our services.
Getting You The Treatment You Need — The Process
In order for a medical procedure to be covered by workers’ compensation, it must meet three factors. Those factors are whether the treatment or procedure is:
- Related to the work injury
After you request coverage for a specific medical treatment, the insurance company might ask you to submit to an independent medical examination — this is common. It may be looking for other treatment options that are less costly or more conservative. The insurer will then either approve or deny coverage for your procedure.
If denied, your case does not need to end there. You and your attorney will be able to present evidence before a workers’ compensation judge. The judge will carefully review your case, including listening to testimony and reviewing your medical records, before he or she offers a ruling. At DeJean & Leger, we know the arguments that need to be made, and we know the proof you need to provide. We have been helping clients with workers’ compensation issues for a long time, and we do it well.
An Example Of Our Success
Our firm recently helped a man who was getting the “run around” from his adjuster. Rather than approving medical treatment recommended by his treating physician, the insurance company relied on a doctor’s opinion who never examined the injured worker. We got to work immediately filing a claim, eventually getting him full coverage for the treatment he and his doctor knew he needed.