Start with the issue actually in dispute
Medication denied is mainly a problem of treatment authorization and medical necessity. Build the file around the written notice, dated record, or event that created the problem.
Documents to gather
Prescription, denial notice, treatment history, prior authorization, and treating-provider rationale.
Questions to answer before acting
- What changed, on what date, and who made the decision?
- Is there a written notice or only a phone conversation?
- Which medical, wage, employment, or incident record directly addresses the dispute?
- What state or federal agency procedure controls the next step?
- Is there a separate employment, third-party, leave, or discrimination issue that should not be mixed into the workers’ compensation question?
Important caution
Identify who denied the medication and what review or appeal process applies.