On December 1, 2021, the Virginia Workers’ Compensation Commission announced that it will launch a pilot program for Petitioning Authorization of Medical Treatment. This pilot program can be utilized by claimants only in certain circumstances:
- An Award must be entered,
- A treating physician is established,
- Both the employer and claimant are represented by counsel, AND
- The request is for medical care of treatment only
After a claimant submits a request for authorization of medical treatment with supporting documentation, the Commission may issue a Notice of Inclusion in Pilot Program for Authorization of Medical Treatment (an example of the Notice is included below for reference). The employer/carrier will have seven (7) calendar days to advise the Commission and claimant whether the care is authorized or denied. Importantly, the individual responding on behalf of the employer/carrier must attest that:
1) they have authority to bind the carrier, AND
2) they also will send a copy of the response to all parties and the treating doctor who requested the treatment
Failure to respond to the notice will result in a telephone conference with the Chief Deputy Commissioner and the parties. Thereafter, an Order will be entered either affirming the authorized care or referring the matter to the hearing docket.
Our PennStuart attorneys have already had several cases in the pilot program, and we are happy to assist with this process and answer any questions. The purpose of the program is to expedite authorization of reasonable, necessary, and causally related medical treatment in uncontested cases. To avoid delays in medical treatment, and to avoid potential sanctions from the Commission, we encourage carriers/employers to promptly authorize any uncontested medical treatment, whether requested through this program or by some other method. If it is unclear whether the requested treatment is reasonable, necessary, or causally related to the accident pursuant to Va. Code. Sec. 65.2-603, or if you have any questions about the Commission’s new program, please do not hesitate to reach out to our workers’ compensation attorneys to discuss any questions you may have.
SAMPLE NOTICE:
This information is provided for general, informational purposes only and does not constitute legal advice or give rise to an attorney-client relationship of any kind between any reader/user and PennStuart or any of its attorneys. Readers should contact their individual attorney for a determination whether this information is applicable or appropriate to their particular situation.