What Is an Extent of Injury Dispute?
Posted By Recalde Law Firm || 7-Sep-2015
An extent of injury dispute occurs when an insurance carrier contests new medical information that arises as part of a workers’ comp claim.
Many serious injuries do not fully manifest at the time of the accident. When these injuries do come to light, the insurance carrier may file a dispute to contest the full extent of the injury.
For example, suppose that a worker falls and hurts his back while on the job. No meaningful tests (such as an MRI) are performed during the initial visit, so the injury may be diagnosed as a lumbar sprain. Time goes on, but the injury does not get better—the doctor orders an MRI, and the results show that there are serious problems with the worker’s back.
The doctor’s additional testing reveals that the worker has suffered a disc protrusion, which requires surgery and other medical treatment, far more than a simple lumbar sprain.
When medical tests show evidence that a workplace injury is much worse than the initial diagnosis and requires more medical treatment and attention, often time the insurance carrier will file a Plain Language Notice or PLN, disputing the extent of the injured worker’s injuries. At this point, the injured worker must present medical evidence to establish that the more serious condition is a result of the work related accident. This dispute by the insurance carrier will delay medical treatment or even deny compensation that the injured worker needs in order to recover from his or her injuries.
Suppose that the injured worker with an MRI that reveals disc protrusion receives a dispute from the carrier claiming that the disc protrusion did not result from the workplace injury. If the nothing is done about it, the injured worker may only obtain compensation for a sprained lumbar, rather than the full medical treatment for the disc protrusion.
If the insurance carrier files an extent of injury dispute, you will likely undergo the dispute resolution process through the Texas Department of Insurance - Division of Workers’ Compensation. This is a crucial step in the legal process of obtaining just compensation for your injuries. Depending on the outcome of the dispute, you may not get the full amount of benefits that you need. Your benefits could also be delayed, or in some cases, denied entirely.