How to Get Reasonable or Necessary Medical Treatment

[Mr. Picket]

Buried in all the Connecticut Workers Compensation Title 31 Chapter 568 Statutes pages of "Thou Shall NOT" is this gem, " Thou Shall Care For Injured Workers"

Sec. 31-294d. Medical and surgical aid; hospital and nursing service. (a)(1) The employer, as soon as the employer has knowledge of an injury, shall provide a competent physician or surgeon to attend the injured employee and, in addition, shall furnish any medical and surgical aid or hospital and nursing service, including medical rehabilitation services and prescription drugs, as the physician or surgeon deems reasonable or necessary. The employer, any insurer acting on behalf of the employer, or any other entity acting on behalf of the employer or insurer shall be responsible for paying the cost of such prescription drugs directly to the provider.


Reasonable or Necessary medical treatment as determined by the physician or surgeon is the chief operative
clause of the Workers Compensation Statute, don't let them tell you otherwise. Stand your ground!

Why are we not getting what the statute and courts have ordered?

[BvIA]

Why are we not getting what the statute and courts have ordered?

Because the defense... employer/carriers have the right to dispute what the treating physician, with the presumption of correctness, recommends.

as the physician or surgeon deems reasonable or necessary.

The underlying quesiton is... what is "reasonable/necessary"... you could have 100 Dr's to opine on this...with 50 differing opinions... and a judge rule based on be most compelling reasoning.

[Mr. Picket]

I made an error copy and pasting the question with the wrong topic. I will repost below this reply the correct question "Why are our CT lawmakers above the law when it comes to benefits in Workers Compensation? This might be a good dual thread because Reasonable and Necessary determined by the physician is the cornerstone of Connecticut Workers Compensation ACT Statute Title 31 - Chapter 568 and there has been a good question posed here.

What is presumption of correctness? Where is that language found in the CT Workers Compensation ACT?

Workers Compensation in Connecticut is an Administrative Agency the last time I looked at (9:57am). The Executive Branch of Government makes appointments and the administration is the responsibility of the Department of Administrative Services, where the appointees are administrative heads known as commissioners.

Therefore, the commissioners have no business "ruling" what is a compelling reasoning for treatment of workers relative to a workplace injury.

Where in the Connecticut Statute does it say commissioners may determine "reasonable or necessary" medical treatment?

---------- Post added at 07:10 AM ---------- Previous post was at 07:03 AM ----------

Connecticut Lawmakers and Workers Compensation Commissioners Are the 1 % leaving paying their way. The following is from the CT Workers Compensation Act there they have legislated rights above the worker to increase their benefits while taking away our to their own self interests and the insurance lobbyists that support their campaigns.

"Connecticut Workers Compensation ACT Section 31-310b Average Weekly Wage of General Assembly Member - (Code for your elected Legislator and Senate Representative) "

"For purposes of workers' compensation the average weekly wage of a member of the General Assembly shall be construed to be the average weekly earnings of production and related workers in manufacturing in the state as determined by the Labor Commissioner in accordance with the provisions of section 31-309. For the purposes of this section, there shall be no prorating of benefits because of other employment by a member of the General Assembly."

This lets Connecticut Legislators double dip! Our benefits under the workers compensation act are reduced by other income! I think all workers should have this same privileged or no one has it. This is the stuff protests are made of.

This is the same reason Legislators don't care about health insurance because they have golden policies that cover everything.

[BvIA]

Therefore, the commissioners have no business "ruling" what is a compelling reasoning for treatment of workers relative to a workplace injury.

WC is administrative law... yes, the "commissioners" of the WC board are the same as "judges" in formulating the rules necessary to impliment the legislative intent in the statute. Yes...the commissioners would be the trier of fact in resolving disputed medical issues.
If you want to appeal the commissioners findings... you go to the state court of appeals...up to the state supreme court if necessary and you have the wherewithall... attorney cooperation.

What is presumption of correctness?

Means the legislature has allowed your treating physician to diagnose, and recommend the appropriate treatment without the use or reliance of treatment guidelines as might be found in ACOEM, ODG or other EBM/Evidence Based Medicine protocol. Much the same as though you were paying out of pocket, or using your own health coverage.
The only time there wouldn't be the ability of a carrier, or medicare to dispute treatment, is if you actually were paying out of your pocket, you could have anything you want the Dr would order.

Litigation is necessary when there are disputes...the law provides for a court/commissioner as the case my be, to resolve those disputes. Otherwise, the parties could argue til the cows come home... and you know how stupid a cow is...

[Mr. Picket]

Ah-hem,, excuse me....
What is presumption of correctness? Where is that language found in the CT Workers Compensation ACT?

Where in the Connecticut Statute does it say commissioners may determine "reasonable or necessary" medical treatment?

[BvIA]

Ah-hem,, excuse me....
What is presumption of correctness? Where is that language found in the CT Workers Compensation ACT?

You understand "presumption", and "correctness"... you don't need a law/statute to define those words. However, the law does provide for the physician of correctness... as you pointed out.

Where in the Connecticut Statute does it say commissioners may determine "reasonable or necessary" medical treatment?

Not sure what you're looking for... the Constitution provides for WC, the legislature makes the laws that implememnt the law, the legislature provides for the governor to appoint commissioners... the commsissioners or Dept of Ins/WC, is the "court"... you can't take everything to civil or supreme court at the first attempt at resolving disputed medical issues.

A commissioner or "WC judge", administrative law judge, is appointed as the "trier of fact", in making awards. Or, determining the disputed issues in a claim.

In Calif WC, the PTP used to have the presumption of correctness, just like CT.
The legislature changed that, and the DWC incorporated the "rule" into the Title 8 CCR's.

Chapter 4.5. Division of Workers' Compensation
Subchapter 1. Administrative Director--Administrative Rules
Article 5.5.2. Medical treatment utilization scheduleNew query

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§9792.25. Presumption of Correctness, Burden of Proof and Strength of Evidence.
(a) The MTUS is presumptively correct on the issue of extent and scope of medical treatment and diagnostic services addressed in the MTUS for the duration of the medical condition. The presumption is rebuttable and may be controverted by a preponderance of scientific medical evidence establishing that a variance from the schedule is reasonably required to cure or relieve the injured worker from the effects of his or her injury. The presumption created is one affecting the burden of proof.

http://74.6.239.84/search/srpcache?e...4Ur1BxLz31Ow--

[Mr. Picket]

Is that all you got?

[BvIA]

Is that all you got?

You want me to do all the work for you?
You can find the answers in the CT WC Act.

As to presumption... I've posted that info in the past. It's there.

[Mr. Picket]

You can K.M.A.

[BvIA]

Little late isn't it, my last post here was in MARCH... where have you been?