Getting injured on the job is stressful enough — but getting necessary medical care approved can be even more frustrating. Many workers are surprised to find that even after a legitimate injury, the workers’ comp system delays or denies treatment they urgently need.
At Employees First Labor Law, we help injured workers fight through the red tape and get their treatment authorized, fast.
🔹 Step 1: Get Your Injury Accepted
Before medical treatment is approved, your claim must be:
- Reported to your employer ASAP
- Accepted (not denied) by the workers’ comp insurance carrier
If your claim is still under review, the insurer is still required to authorize up to $10,000 in treatment while investigating, per Labor Code §5402(c).
🔹 Step 2: Treat Within the MPN (Medical Provider Network)
Most employers have a Medical Provider Network (MPN) — a group of doctors approved by the insurer. To get treatment approved:
- Choose a doctor within the MPN
- Make sure they submit Request for Authorization (RFA) forms for any treatment needed
- Avoid seeking treatment outside the network without written approval
⚠️ If you pre-designated your own physician before the injury, you may have the right to treat with them instead.
🔹 Step 3: Understand Utilization Review (UR)
Even if your doctor recommends treatment, it must go through Utilization Review:
- The UR team decides if the treatment is medically necessary
- They must respond within 5 business days
- Commonly denied treatments: MRIs, surgeries, long-term physical therapy, specialist referrals
If the UR denies or modifies your request, don’t panic — you can appeal.
🔹 Step 4: Request an Independent Medical Review (IMR)
If UR denies treatment, you have the right to challenge it via Independent Medical Review (IMR):
- Must file within 30 days of the UR denial
- IMR is conducted by a neutral physician
- Their decision is binding, but can be appealed in limited circumstances
We often assist clients with IMR filings to ensure the strongest possible case is presented.
🔹 Step 5: Consider a QME/AME Evaluation
If your treatment is repeatedly denied or disputed, a Qualified Medical Evaluator (QME) or Agreed Medical Evaluator (AME) may be necessary. These experts:
- Examine you
- Review medical records
- Issue reports that affect treatment and benefit eligibility
We help coordinate QME/AME evaluations and challenge biased or insufficient findings.
🔹 Why Treatment Is So Often Delayed or Denied
Insurance companies delay treatment because it:
- Saves them money
- Reduces disability payouts
- Makes you more likely to settle early (and cheaply)
We fight back by building strong medical records, pushing through authorizations, and exposing bad faith practices that delay your recovery.
🔹 Why Choose Employees First Labor Law?
At EFLL, we don’t just wait around for insurers to play fair. We:
- Push for fast approval of urgent care
- Challenge UR denials and coordinate IMR
- Force compliance with timelines under the Labor Code
- Take legal action when treatment is unreasonably delayed or denied
- Handle both workers’ comp and civil retaliation or discrimination claims when relevant
If you’re being denied medical care, you’re being denied your right to heal. We make sure you get what you need — now, not later.
✅ Get Help Today
If you’re struggling to get treatment approved after a workplace injury, contact Employees First Labor Law today. We’ll make sure you get the care you’re owed — and hold the insurer accountable if they delay it.
