Navigating workers’ compensation policies for your Durable Medical Equipment (DME) needs can be a complex process, but it’s crucial to ensuring you receive the proper care and support after a workplace injury.
Understanding what constitutes DME is the first step. DME is equipment that is prescribed by a healthcare provider for a patient’s use in their home, and must meet certain criteria. It should be reusable, primarily and customarily used to serve a medical purpose, and generally not be useful to a person in the absence of an illness or injury. Examples include walkers, wheelchairs, hospital beds, and certain types of monitoring systems like blood sugar monitors for diabetics1234.
After an injury in the workplace, workers’ compensation insurance should cover the cost of necessary DME. However, getting approval for this equipment can sometimes be challenging. All medical treatment within workers’ compensation, including DME, is subject to Utilization Review and Independent Medical Review. Doctors are required to provide a “Request for Authorization” for such equipment, and insurance companies can either approve it or send the request to Utilization Review. If the item is denied by Utilization Review, the injured worker can seek an Independent Medical Review of the Utilization Review Determination5.
When navigating this process, it can be beneficial to enlist the help of a knowledgeable attorney who specializes in workers’ compensation. They can guide you through the steps and help fight for your right to necessary medical equipment.
Remember that each state has its own workers’ compensation laws, so the specifics of these processes may vary depending on your location. Always consult with a professional to get accurate and personalized advice.
Please note, this is a general overview and does not account for specific state laws or individual circumstances. For more detailed and personalized advice, it’s always best to consult with a legal or medical professional.