What If the Workers’ Comp Insurance Company Won’t Authorize My Treatment?
Calling the adjuster again is not the same thing as having a legal remedy.
What the Law Says THE SHORT ANSWER. In Missouri, the employer/insurer selects the authorized treating physician (RSMo § 287.140) — and owes you the medical treatment reasonably required to cure and relieve the effects of the work injury. When the authorized doctor recommends an MRI, injections, therapy, a specialist referral, or surgery, and the carrier delays or ignores the request, that is not just an administrative annoyance. Missouri provides a formal legal process for exactly this dispute — and there comes a point where using it matters more than another phone call.
I’ve Seen This Before A pattern I see over and over: the doctor’s office insists the authorization request went out, the adjuster insists nothing ever arrived, and the injured worker sits between them, hurting. So the request gets sent again. It vanishes again. Nobody is technically saying no — and that’s exactly what makes it so hard to fight with phone calls alone. A request that keeps disappearing is not a paperwork problem; it’s a dispute, and disputes have legal remedies.
FIRST MOVES (DAYS, NOT WEEKS). Confirm the doctor’s office actually submitted the authorization request, and get the date it was sent. Ask the adjuster — in writing, politely — for the status and for a decision date. Keep a dated log of every contact. Ask the doctor’s office to document the medical need in the chart. None of this requires a lawyer, and sometimes it resolves the problem.
WHEN NOTHING HAPPENS. If medically recommended treatment sits unauthorized while you wait in pain — or the carrier simply goes silent — Missouri’s formal tools include: filing a Claim for Compensation with the Division (which opens a contested case), requesting a hardship hearing on the grounds of undue hardship or under § 287.203 (8 CSR 50-2.010(13)), where an Administrative Law Judge can hear the treatment dispute on an expedited basis and order relief supported by the evidence.
A hardship proceeding is litigation: it involves medical evidence, often deposition or report testimony, and a judge — not a strongly worded email to the adjuster.
WHAT A LAWYER CAN DO THAT REPEAT CALLS CANNOT. File and prosecute the claim; demand the dispute be set for hearing; obtain and present the medical evidence a judge needs; depose the doctors; push a hardship setting; and create the one thing an unrepresented phone call never creates — consequences for continued delay.
The Division itself lists denied or inadequate medical care among the situations where consulting a lawyer may be appropriate, and notes that attorneys who regularly practice comp generally offer free consultations.
NURSE ATTORNEY NOTE. From the medical side: delay is not neutral. Untreated conditions stiffen, weaken, and worsen — and gaps in treatment also get read later, unfairly, as evidence you were fine. If care your authorized doctor ordered is sitting in limbo, the clock is not your friend. When care has been refused or left hanging, this is the work we do every week. Our page on refused treatment and denied workers’ comp claims explains how we take it to a judge.
Sources: RSMo §§ 287.140, 287.203; 8 CSR 50-2.010(13); Mo. Division of Workers’ Compensation guidance. Educational information, not legal advice.
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