April 27, 2015

How do I collect medical and rehabilitation benefits?

Your medical and rehabilitation should be under the direction of your physician or other health practitioner, and he or she should recommend appropriate treatment. Some injuries that fit certain legally defined injury categories do not require the insurer’s prior approval in order to receive benefits to fund assessments or treatment. In other cases, the treatment provider must complete a treatment and assessment form, which requires your signature, to obtain permission from your insurer to conduct an assessment or provide treatment. If your insurer agrees that you require the assessment or treatment, they will notify your treatment provider and an assessment can then be done and a treatment plan can be developed, which is then sent to your insurer for funding consideration.

In order to help ensure that your assessment and treatment is not delayed significantly, your insurer has 10 business days to approve a request to conduct an assessment or to approve a treatment plan. If your insurer misses this deadline, the request is considered approved until the insurer ultimately responds. If your insurer does not approve a request to assess or a treatment plan, your insurer may decide to have you assessed by a health practitioner of their own to assist them in their decision. If your insurer maintains its decision, you can either withdraw the request for the benefits, or seek to have your disagreement discussed in the presence of a mediator. Possible further legal steps are arbitration or a lawsuit against your own insurer.

If you have any additional questions, please feel free to contact us.