What is a common cause of disputes in workers' compensation claims?

Disagreements over medical necessity or injury extent are a prominent source of conflict in workers' compensation claims. This is primarily because both employers and insurance companies often seek to limit their exposure to costs associated with claims. When a worker sustains an injury, assessing the necessity and appropriateness of medical treatment can lead to disputes. Insurance adjusters may challenge whether specific treatments are warranted or if the reported extent of the injury matches the medical information provided. These disagreements can arise from differing opinions between medical professionals, the insurance provider, and the injured worker regarding the proper course of treatment.

Additionally, these disputes can complicate the claims process, leading to delays in compensation and treatment for the injured worker, further intensifying disagreements. By understanding the nuances of medical necessity and how it relates to the injury claimed, adjusters are better equipped to navigate and resolve these common disputes effectively.