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Why Must My Medical Treatment Be Authorized?

John Lesaganich Nov. 15, 2022

During the course of related medical care and treatment following a work-related accident or manifestation there will likely be a point in time where the injured worker needs to be seen by a specialist and/or need expensive diagnostic testing (i.e. MRI, EMG/NCV, CT/Myelogram). Specialists and the hospitals and clinics which provide the aforementioned diagnostic services will likely require that such services be authorized by your employer’s insurance company before you are permitted to see the specialist or be tested. The necessity of authorization is absent from the text of the Illinois Workers’ Compensation Act. Instead, it is a product of the way specialists, hospitals and clinics choose to do business. Succinctly stated, authorization means that the medical provider wants to know that its bill will be paid before that bill exist

An Experienced and Persuasive Peoria Workers’ Comp Lawyer

At John Lesaganich, P.C., Attorney at Law acquiring authorization for related medical care and treatment is a hot button issue. Many times an experienced workers’ compensation trial lawyer with a reputation of successful trial work can by reason obtain authorization for reasonable and necessary medical care. Just as in the case of unreasonable delay in the payment of TTD benefits, the employer can be penalized for failure to timely authorize reasonable and necessary medical care if it can be shown that the refusal to authorize care was without just cause. The injured workers’ attorney may also place the facts of the case, the law and relevant medical records on the desk of the Arbitrator at a pre-arbitration meeting intended at persuading the Arbitrator to recommend that the employer authorize the care sought. Finally, there is a legal method whereby the Illinois Workers’ Compensation Commission can order the employer to authorize the reasonable and necessary medical care the injured worker requires. However, remember that once the arbitration process is set into motion it becomes a time consuming process.

In the face of denial of authorization from your employers workers’ compensation insurance company it is totally appropriate for the injured worker to utilize available collateral insurance sources (i.e. group health insurance, private insurance policy or public aid). Utilization of such collateral insurance sources does not prejudice your case. In fact, the use of such collateral insurance sources in the face of workers’ compensation authorization denial is smiled upon by Arbitrators. For, use of such collateral sources moves the case forward. But, an experienced workers’ compensation trial lawyer knows that at the conclusion of the injured workers’ claim that there must be a reckoning with the collateral source. Such a reckoning would be an element of the injured workers’ settlement or Arbitrator’s award and not detract in any way from those monies to which the injured worker is entitled had the authorization been extended voluntarily at the beginning.

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Contact our office or toll free to talk with attorney John Lesaganich about your workman’s comp benefits. At our office, initial consultations are always free and confidential. We are located on Main Street in downtown Peoria, across from the courthouse.