Medical Authorization:
How Treatment Gets Approved
How Treatment Gets Authorized Under the LHWCA
The basic rule
Before you receive medical treatment other than emergency treatment, authorization has to be requested from the employer or the insurance carrier. That's the gate. The LS-1 is how it's usually opened.
After authorization, your doctor can move
This is the part worth understanding, because it's where a lot of delay gets introduced unnecessarily. Once treatment has been authorized, your treating physician may refer you for diagnostic testing and non-surgical treatment as your injury requires.
​
In other words, your physician doesn't have to go back to square one for every X-ray or course of therapy. A clinic that understands this keeps your care moving. A clinic that doesn't will leave you waiting for approvals that were already covered.
What's included
Your entitlement covers reasonable and necessary treatment for the work injury medical and surgical care, hospital treatment, prescription medication, diagnostic testing, physical therapy, prosthetics, hearing aids, attendant care where needed, and travel costs for treatment.
What the carrier can push back on
Carriers can and do dispute whether treatment is necessary, how often it's needed, what type it should be, and what it costs.
​
They can also raise distance. The care has to be reasonable in geographic terms if equivalent treatment is available locally, a carrier may decline to authorize the same care somewhere far away.
When there's a dispute
Disputes about medical treatment go first to the Longshore district director or the assigned claims examiner, who tries to resolve them informally. If that doesn't work, any party can ask for the dispute to be referred to an Administrative Law Judge for a formal hearing.
​
If you're stuck, contact the claims examiner assigned to your case. That's what they're there for.
The carrier's own examination
Separately from your treatment, the insurance carrier may schedule a medical evaluation with a physician of its choosing at a reasonable distance from where you live. If you refuse to attend, your compensation can be suspended until you do. OWCP can also schedule an examination. If one is scheduled, go and tell your treating physician it happened.
What we do
We write authorization requests that state what's being asked for, why it's medically necessary, and how it relates to the injury. Because vague requests are the ones that get denied. We respond to carrier and case manager questions within one business day. And we document treatment necessity as we go, so that if there is a dispute, the record already answers it.
Navigating Your Medical Rights
Under the LHWCA, you have the right to choose your own physician. You are not required to see a doctor selected by your employer or insurance carrier. This ensures your medical care is focused solely on your recovery and accurate documentation of your injury.
Have questions about your claim or need a medical evaluation?