Key takeaways
A treatment denial should be tied to the requested treatment, the reason for denial, and the medical-review process.
Records to put together
- Treatment order/referral
- Denial or utilization-review notice
- Relevant diagnostic records
- Treating provider rationale
Questions to verify
- Who denied the treatment and why?
- What review or appeal step is available?
- Can the provider submit additional support?
- Does a deadline apply?
Important caution
Medical-review systems vary by state; use the official agency or insurer notice for the correct procedure.
When a lawyer consultation may help
- A deadline, hearing, denial, or benefit change is close or disputed.
- The medical evidence and the insurer/employer position conflict.
- Permanent restrictions, settlement, third-party liability, employment status, or retaliation may affect the file.