When you’re injured at work, your number one priority is making a full and complete recovery. One way in which people make fuller recoveries is by getting medical treatment or even surgery, but insurance companies don’t always approve every procedure, even if it may help your situation. If you run into a situation where your insurance company won’t pay for a procedure you feel is necessary, you can request a hardship hearing.
But what is a hardship hearing, and how can you ensure you get a good result from this hearing? We answer those questions and more in today’s blog.
Requesting A Hardship Hearing
A hardship hearing is a conference that can be requested if your medical claim request has been denied while you’re in the process of recovering. Insurance companies didn’t turn into profit giants by greenlighting every surgery at the first request, and cost is often a big factor in whether or not they approve a treatment, even though the deciding factor is supposed to be whether or not the patient needs the operation. Your insurance company may pay for a knee brace, but they’ll deny coverage for a knee operation. If you truly believe you need the knee surgery and can prove it, you can request a hardship hearing.
During a hardship hearing, both sides (patient representation and insurance company representation) will argue their case before a judge. A lot of different factors may be brought up during the hearing, including previous injuries to the knee, whether or not conservative treatment options would be useful, and the testimony of medical experts.
If the judge rules in your favor, the surgery will be covered by workers’ compensation. If the judge rules for the insurance company, you won’t be able to have the procedure paid for at the current time, but your whole case will still remain open if you are in the process of healing. As long as you’re still in the process of healing, the claim remains open, and this can allow you to contest future care denials through additional hardship hearings.
Final Hearing
Finally, once you’ve reached maximum healing, you can request what’s known as a final hearing. At this conference, a judge will hear cases from both parties and award compensation for your injury and medical treatment. Once this decision is given, and if neither side appeals, it is considered a final ruling and the case is closed, meaning no more compensation will be granted. Either you or your employer can request a final hearing, so don’t be surprised if they try to push for a final hearing to put an end to their liability.
If you are considering filing a hardship or final hearing, it is in your best interest to not only talk to a workers’ compensation lawyer, but to hire one to help with your case. They know how to fight back against the insurance company’s claims, and they can help prove that your medical care is not only warranted, but necessary. For assistance with a hardship or final hearing, or any other aspect of your injury case, pick up the phone and give the experienced lawyers at Hey Workers a call.
