Workers' Compensation Client Assistance

My check or direct deposit didn't arrive on its normal day. What should I do?

Although checks and/or direct deposits may normally arrive on a particular day, there are certain factors that can cause your mail to be delivered late, sometimes as much as 5 or 6 days. If your check or direct deposit doesn't arrive when it usually does, please wait one week. If it still hasn't arrived at that time, reach out to Matt through the Case Status app and/or by text message. Matt will contact your insurance carrier to confirm that it was sent. If it was, Matt will request that the payment be re-issued. Getting the new payment usually takes about another week. Unfortunately, there is not much Matt can do to speed up this process.

I just received a document in the mail. Did Matt get it?

Matt should receive a copy of (a) all mail that comes from the Department of Insurance, (b) all mail comes from your insurance carrier, and (c) any forms that are submitted by your doctors (including your designated doctor) with the state. Check to see if Matt's name is listed as someone receiving the document. If it is, there is no need to contact us to make sure we got it. If you receive something, and you don't see Matt's name, please reach out to Matt through the Case Status app or text message and let him know.

The insurance company refused to approve medical treatment requested by my doctor. What happens next?

Matt can ask for the insurance company to reconsider its decision. If it doesn't change its mind after it is asked to reconsider, he can ask for an independent organization to review the decision. This process usually takes about 30-60 days after Matt makes his initial request for reconsideration. However, before Matt can take any action, you need to provide him with one of two things: 1. A copy of the document issued by the insurance company that refused to precertify your treatment, or 2. A copy of a written request made by your doctor for the treatment. Before contacting us about a refusal to approve treatment, please make sure you have provided us with one of these two documents. If you don't have either of these documents, please ask your provider for them. If your provider did not submit the request in writing, please ask them to do so, and to send a copy to Matt.

The insurance company hasn't responded to a request to approve treatment. How can we get it approved?

The insurance company is supposed to respond to requests to approve treatment within a very short time-frame, usually only a few days. If your request has been pending for more than a week, Matt can make a demand on the insurance company to issue a decision as to whether the treatment is approved. However, before Matt can make this demand, you (and/or your provider) will need to send us the written request for the treatment. Most of the time, when an insurance company hasn't responded to a request to approve treatment, it is because the provider did not submit the request in writing. Insurance companies routinely ignore such requests, and will usually claim that "nobody ever submitted anything" when we inquire about it. For that reason, we need proof (in writing) that the request was made. If your provider did not submit anything in writing, you should ask them to do so, and to send us a copy.

I received a letter in the mail stating that I have to attend a medical examination. Why is that? What is the reason for the examination?

Matt will normally receive the same letter about your examination at the same time you do, but it may take a day or two for it to be scanned and processed into our system. Once he receives it, he will provide you with more information regarding the details of the examination. However, generally speaking, there are two types of examinations. The letter that you have received should tell you which type of exam has been scheduled. 1. THE DESIGNATED DOCTOR EXAMINATION The Designated Doctor is a neutral doctor who is appointed by the State to conduct an examination and render an opinion on issues that are disputed in your case. These examinations are usually requested either by Matt or the insurance company, but are sometimes requested by a representative of the State. The designated doctor's decision can have a large impact on your case, and will carry a lot of weight if your case gets decided by an administrative judge. 2. THE REQUIRED MEDICAL EXAMINATION This is an examination conducted by a doctor that is hired by the insurance company. This doctor will likely produce opinions that are harmful to your case. However, those opinions not carry as much weight.