What Does Authorized Medical Treatment Mean in an Alabama Workers’ Compensation Claim

What Does Authorized Medical Treatment Mean in an Alabama Workers’ Compensation Claim?

One of the most common sources of confusion in Alabama workers’ compensation claims involves something called authorized medical treatment.  Many injured workers assume that because they were hurt at work, workers’ compensation must pay for any doctor, specialist, or medical treatment they choose, but that is not how the Alabama workers’ compensation system works.

In fact, one of the most common reasons injured workers receive unexpected medical bills is because the treatment was not considered “authorized” under Alabama’s Workers’ Compensation Act.

What Is Authorized Medical Treatment?

Authorized medical treatment is medical care that has been approved through the workers’ compensation system.  Generally speaking, Alabama workers’ compensation carriers are responsible for paying for:

• authorized physician visits;
• authorized specialist care;
• authorized surgery;
• authorized physical therapy;
• authorized diagnostic testing;
• authorized prescription medication; and
• other reasonably necessary treatment related to a work injury.

The key word is Authorized.

Who Chooses My Workers’ Compensation Doctor?

Unlike private health insurance, Alabama workers’ compensation law generally allows the employer or workers’ compensation carrier to select the initial physician who will treat the injured worker.  This physician is commonly known as the Authorized Treating Physician.

The Authorized Treating Physician serves as the doctor responsible for directing medical treatment related to the workplace injury.

Why Does Authorization Matter?

Authorization matters because workers’ compensation generally pays for treatment provided through the authorized chain of medical care.

For example:

• The Authorized Treating Physician may order an MRI.
• The Authorized Treating Physician may refer you to an orthopedic surgeon.
• The orthopedic surgeon may recommend physical therapy.
• The orthopedic surgeon may refer you to a pain management specialist.
• The pain management physician may refer you to a psychologist.
• Etc.

When properly referred, these providers generally become part of the authorized treatment chain.

Can I See My Own Doctor?

You are generally free to see any physician you choose; however, that does not necessarily mean workers’ compensation will pay the bill.  This is where many injured workers encounter problems.  For example:

Suppose an injured worker becomes frustrated with treatment and schedules an appointment with a physician on their own.  Even if that physician recommends treatment related to the workplace injury, the workers’ compensation carrier may argue that the treatment was not authorized and refuse payment.  As a result, the worker may become personally responsible for the medical expenses.

What Happens If I Need a Specialist?

In many cases, the Authorized Treating Physician may determine that specialized treatment is necessary.

The physician can refer the worker to:

• orthopedic surgeons;
• neurologists;
• neurosurgeons;
• pain management physicians;
• physical therapists;
• psychiatrists or psychologists, or
• other specialists.

When properly referred through the authorized treatment process, these specialists generally become authorized providers as well.

What If I Am Unhappy With My Doctor?

Alabama law provides a mechanism known as the Panel of Four.

Under certain circumstances, an injured worker may request a list of four physicians from which a replacement physician can be selected. The Panel of Four process is often one of the most important rights available to an injured worker who is dissatisfied with their medical treatment, but it can only be used once during the pendency of a claim, so it is not something to be done without consideration.

Are There Exceptions to the Authorization Requirement?

Yes.  While authorization is important, there are situations where disputes arise regarding medical treatment.  Examples may include:

• emergency treatment;
• refusal by workers’ comp to provide medical care;
• unreasonable delays in treatment;
• denial of recommended treatment; or
• other circumstances where the employer fails to fulfill its obligations.

It is not uncommon for treatment obtained outside the normal authorization process to become the subject of litigation.

Does Authorized Mean the Treatment Must Be Paid For?

Generally, yes, but not always as authorization and compensability are related but different concepts.  Even authorized treatment may become the subject of disputes regarding:

• medical necessity;
• utilization review;
• causation;
• future treatment; or
• whether the treatment remains related to the work injury.

This is why terms such as:

• Authorized Treating Physician;
• Reasonable and Necessary Medical Treatment;
• Utilization Review;
• IMEs and
• Medical Causation

often arise together in workers’ compensation claims.

At Powell and Denny, we have spent over three decades helping injured workers throughout Alabama obtain the medical treatment and benefits to which they are entitled under the law.

If you have suffered a job injury and you have questions about your rights and benefits under Alabama’s workers compensation laws -don’t hesitate to contact and speak with one of the experienced Alabama Workers Compensation and Social Security Disability attorneys at Powell and Denny today for a free consultation. Appointments are available in person, or virtually via Zoom if more convenient.  Powell and Denny would appreciate the opportunity to help.  And remember, there is no fee unless you win.

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Offices in Birmingham and Huntsville, Alabama