The answer to this question is not always an easy one. First, you need to get your health care provider to forward the request to your insurance company. Then, according to Minnesota Workers Compensation Rule 5221.6050, the insurer must respond orally or in writing to the health care provider’s request within seven working days. If the health care provider does not receive a response from the insurer within the seven working days, authorization is deemed to have been given. See Minnesota Workers Compensation Rule 5221.6050 subp. 9c(1). There are several ways that the insurance company can delay this further.
The insurance company can approve the request, deny the request, request additional information, request a second opinion, or request an Independent Medical Exam (IME). Depending on the response, the insurance company could have additional time to make a decision. For instance, if the insurance company requests additional information, they will have an additional seven business days to make a decision after the additional information has been received. The more common response is to request and IME.
If the insurer notifies the health care provider of the IME within seven working days, the proposed non-emergency surgery may not be provided pending the examination. However, after 45 days following the insurer’s request for an examination, the health care provider may elect to go ahead with the procedure and if the procedure is ultimately determined to be compensable by a judge, they will be paid.
Minnesota work comp has many rules and regulations. Insurance companies know these rules like the back of their hand. If left unchecked, these rules can be used to delay your case, or worse prevent you from getting benefits. However, if you know what the rules are and how to use them, they can made to work for you, not against you.
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