The insurance company denied my claim but I need medical treatment. Can I use my private medical insurance?

If your claim is denied, you can your private medical insurance to treat if your insurer is willing to do so. Keep a ledger of all of your out of pocket expenses including mileage and copays (if you have to make one). If the claim is ultimately accepted by the workers’ compensation carrier, your private medical insurance can file a lien with the Workers’ Compensation Appeals Board and try to get reimbursed for the payments they made.

Save your copay receipts and mileage.  Then, if the PQME sides in your favor, you can demand compensation for your out-of-pocket copays and mileage.

Once a claim is denied, a carrier can’t object to treatment that’s reasonably necessary to cure or relieve the effects of your work related injury. Also, track of all the time you’ve lost from work without pay in order to get reimbursed if EDD is not providing you with benefits.

You may be wise to also consult with a reputable Workers’ Compensation attorney. Not all PQMEs are good at drafting quality reports so it’s important you know which doctor to pick.