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Strong Advocates For Proper Medical Benefits

Under California workers’ compensation, employees are entitled to necessary medical care for a work-related injury. Yet injured workers are routinely denied medical care by employers or tightfisted insurance companies.

The legal team at Koszdin, Fields, Sherry & Katz can step in if you are denied medical benefits. All of the firm’s partners are workers’ compensation specialists* who know how to hold employers and insurers to their obligations. We have successfully appealed claim denials and adverse medical evaluations for clients throughout Southern California.

Denied medical benefits for a work-related injury?
Call today for a free consultation to assert your workers compensation rights. Based in Van Nuys, our law firm represents injured workers throughout Greater Los Angeles.

Can You Choose Your Own Doctor?

The workers’ compensation system is not always friendly to the injured worker. When you seek medical attention for a work-related injury or illness, you cannot necessarily choose your own doctor. You must treat with one of the designated physicians in the employer’s medical provider network (MPN).

Have You Been Denied The Medical Coverage You Need?

Our lawyers can intervene if there is any problem with your medical benefits:

  • Access to medical specialists
  • Authorization for a second opinion
  • Denial of coverage for MRI or other diagnostics
  • Denial of surgery or therapeutic treatment
  • Denial of coverage for medications or medical equipment
  • Denial of your injury claim (not work-related, not serious, etc.)

Our attorneys are well-versed in the workings of the Division of Workers’ Compensation (DWC) Medical Unit and the procedures for appealing adverse decisions.

What About Independent Review Of A Disputed Claim?

Disputed claims may be reviewed by a panel QME (qualified medical evaluator) that you choose from a list. These are physicians who are assigned by the Medical Unit to examine workers and issue medical reports. The QME’s utilization review (UR) is used to determine eligibility for medical benefits and whether proposed treatments are medically necessary.

It is extremely important to immediately contact a lawyer if you receive a request for a QME panel.

Sometimes the panel QMEs cannot provide an objective medical opinion. One option is for the attorney and claim administrator to choose an agreed medical evaluator (AME) to resolve the claim dispute. Under new rules in 2013, injured workers may also request an independent medical review (IMR) when a specific treatment is denied, delayed or modified by a utilization review (UR). This expedited process is handled by a third-party administrator who contracts with the state. Either side can appeal an IMR decision to the Workers’ Compensation Board of Appeals.

Contact Us For Skilled Legal Counsel

It is important to contact an attorney early in the claims process to ensure that you get the quality medical care you need, or to file your appeals in a proper and timely fashion. For a free consultation with our Van Nuys medical benefits attorneys, call 818-812-5639 or (toll free) 800-747-3447 or contact us online. You pay no fees unless we win your case.

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*Certified by The State Bar of California Board of Legal Specialization as specialists in workers’ compensation law

Any person who makes or causes to be made knowingly false or fraudulent material statements or material representation for the purpose of obtaining or denying workers’ compensation benefits or payment is guilty of a felony. Toda aquella persona que sablendo tapa o causa que se produzca cual quier falsas o fraudulentas alegaciones o representación de trabajadores es culpable de un crimen mayor.