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Parker Scheer LLP
Boston Office
1 Constitution Plz
Boston, Massachusetts
02129
Directions
Phone: 617-886-0500
Fax: 617-886-0100
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The Massachusetts Workers' Compensation Act
continues to be the primary source for the payment of medical
expenses incurred to treat a work related injury or condition
provided that the treatment is reasonable, necessary and related
to the claimed injury.
In response to rapidly increasing medical costs,
the legislature enacted provisions to the Massachusetts Workers'
Compensation Act that created a medical management component
with which all injured workers and their medical providers
must comply. Before one seeks non-emergency medical care for
a work related injury, the plan for treatment must undergo
Utilization Review by an agent designated by the workers'
compensation insurance company paying benefits. The insurer
is required to provide a card to the injured worker, which
identifies the UR agent, and includes a toll free number to
contact it.
The role of UR is limited to a determination
of whether the proposed treatment is reasonable and necessary.
Utilization Review does not address issues of the cause of
an injury, but rather focuses upon whether the proposed treatment
is appropriate under the circumstances. In many cases, Utilization
Review is guided by a protocol for the care of a particular
injury.
Most medical care of an injury is subject to
UR. However, there is no requirement that an injured worker
undergo Utilization Review for an office visit. UR is designed
to address treatment plans, which include such care as diagnostic
testing (MRI, CT Scan), physical therapy and chiropractic
treatment, and surgery.
Generally, a medical provider submits a proposed
course of treatment to a UR agent which reviews the proposed
treatment plan to consider whether it is reasonable and necessary.
If the proposed treatment is found to be appropriate, written
approval is issued to the worker and the provider. This does
not guarantee payment, however, as the plan is then submitted
to the insurance adjuster who determines if the treatment,
though reasonable and necessary, is related to the claimed
industrial accident and resulting injury. If it is, then the
employee is free to seek the care; if it is not approved by
the adjuster, then a claim at the Department of Industrial
Accidents must be filed in order to obtain the suggested care.
If the UR agent denies the request for
treatment, then either the injured worker or the medical provider
must appeal the adverse determination by calling the UR agent
or by sending them a written request for an appeal. Under
the regulations, a call is sufficient. The UR agent must then
conduct a peer-to-peer review between the provider who proposed
the treatment plan and a person who practices in the same
field of medicine. If the peer assessment results in another
denial, then the injured worker must file a claim with the
Department of Industrial Accidents in order to have the workers'
compensation insurer pay for the proposed care. If the peer
reviewer agrees that the treatment is reasonable and necessary,
then the claim moves to an adjuster who conducts an inquiry
into the causal relationship issue. Once again, if the adjuster
determines that the treatment is for an injury not related
to the industrial accident, a claim must be filed in order
to secure treatment.
To speak with a highly experienced workers’
compensation lawyer, click
here, or telephone Parker Scheer LLP seven days
a week, toll free at 886-414-0400. There is no fee charged
to discuss your case, and all information furnished will be
kept strictly confidential.
Massachusetts
Workers' Compensation - F.A.Q's
Massachusetts
Premier Workers' Compensation Lawyers
Other Massachusetts Workers'
Compensation Resources
Massachusetts
Workers' Compensation Act
Massachusetts
Department of Industrial Accidents
Injured
Worker's Guide (Publication of Mass. Department of Labor)
The
Workers' Compensation Rating and Inspection Bureau
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Parker Scheer LLP lawyers handle workers' compensation claims in Massachusetts towns including Acton, Amesbury, Amherst, Andover, Arlington,
Ashburnham, Ashfield, Ashland, Athol, Attleborough, Barnstable,
Barre, Bedford, Belmont, Berkley, Berlin, Bolton, Boston, Boxborough,
Boxford, Boylston, Bradford, Braintree, Burlington, Buzzards
Bay, Cambridge, Carlisle, Charlemont, Charlestown, Charlton,
Chelmsford, Chelsea, Clinton, Concord, Danvers, Dedham, Deerfield,
Dudley, Duxbury, East Longmeadow, Essex, Fall River, Fitchburg,
Foxboro, Framingham, Franklin, Freetown, Gardner, Gill, Gloucester,
Granby, Groveland, Hadley, Hamilton, Hanover, Haverhill, Holbrook,
Holliston, Holyoke, Hopkinton, Hubbardston, Hudson, Ipswich,
Kingston, Lakeville, Lancaster, Lawrence, Leominster, Lexington
Lincoln, Lowell, Ludlow, Lynn, Lynnfield, Malden, Marblehead,
Marlborough, Marshfield, Maynard, Melrose, Methuen, Methuen,
Middleborough, Middlefield, Milford, Milton, Monterey, Nantucket,
Natick, Needham, New Bedford, Newbury, Newburyport, Newton,
North Attleborough, North Brookfield, Northampton, Northborough,
Paxton, Peabody, Pepperell, Pittsfield, Plymouth Provincetown,
Quincy, Reading, Richmond, Rockport, Rowe, Rowley, Salem, Saugus,
Sherborn, Southbridge, Spencer, Sterling, Stoughton, Stow, Sturbridge,
Sudbury, Templeton, Topsfield, Townsend, Truro, Upton, Wakefield,
Waltham, Watertown, Wayland, Wellesley, West Boylston, West
Newbury Westborough, Westford, Weston, Westport, Williamstown,
Wilmington, Winchendon, Winchester, Woburn, Worcester, Yarmouth.
Parker Scheer also provides referral services for personal injury
lawyers in states other than Massachusetts.
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