If the insurer denied treatment your doctor requested, the dispute usually turns on paperwork: the request for authorization, Utilization Review decision, medical records, and deadlines for Independent Medical Review.
A denial does not automatically mean the care is over. It means the record has to be built quickly and correctly before the insurer's version becomes the only version.
UR and IMR deadlines can be short. If you receive a treatment denial, keep the entire notice and get advice before the deadline passes.
If anything changed after you reported the injury, write down the date, who was present, and what documents exist.
Save these treatment-denial records
- The written denial or Utilization Review notice
- The doctor's request for authorization and work-status slips
- Medical reports explaining why treatment is needed
- Adjuster letters, portal messages, texts, and voicemails
- Dates treatment was requested, denied, delayed, or cancelled
- Receipts for out-of-pocket medical costs, travel, braces, medication, or imaging
How WCLG helps with denied treatment
- Identify whether the dispute belongs in UR/IMR, WCAB, or another claim process
- Review whether the treating doctor's request was documented clearly enough
- Push for the medical records and deadlines that control the treatment dispute
- Protect related wage-benefit issues when a denial keeps you from healing or returning to work
Common Questions
Is a treatment denial the same as a claim denial?+
No. A treatment denial usually means the insurer disputes a specific medical request. A full claim denial disputes whether your injury is covered at all. The deadlines and procedures can be different.
Can I see my own doctor after treatment is denied?+
It depends on your medical provider network, predesignation, and claim status. Do not assume private treatment will be reimbursed without reviewing the rules for your case.
Should I keep going to appointments?+
Usually yes, if appointments are authorized and medically appropriate. Gaps in care can give the insurer arguments later. Ask a lawyer if treatment access is unclear.