In Vermont, employers—or their insurance carriers—are required to pay for all reasonable, necessary, and work-related medical treatment and medications, at rates established by the Vermont Department of Labor. While this principle seems straightforward, it often gives rise to disputes within the workers’ compensation system.

Why You May Need a Lawyer to Secure Your Medical Benefits

Medical benefits are the most expensive component of workers’ compensation for employers and insurance carriers—accounting for nearly half of all benefits paid out in Vermont. Because of this, employers and insurers have a strong incentive to control the type and extent of medical treatment injured workers receive. Common tactics include:

• Referring the worker to the employer’s or carrier’s chosen doctors

• Assigning a nurse case manager

• Sending the worker to an “independent” medical examination

• Denying preauthorization for treatment

• Refusing to pay for treatment or medication

• Communicating directly with doctors—sometimes inappropriately

These methods are not always used properly. At Jarvis & Modun, we stand up for your right to appropriate care. If an employer or insurance carrier improperly interferes with your treatment, we will protect you. If a legitimate dispute arises over whether treatment is reasonable, necessary, and work-related, we will fight to secure the care that’s best for you.

Choose Your Own Doctor

Choosing a doctor is one of the most personal and important decisions you can make. A strong doctor-patient relationship is built on mutual trust, and your doctor’s decisions directly impact one of the most essential aspects of your well-being: your health. That responsibility shouldn’t be handed over lightly.

In Vermont, an employer may initially direct you to a doctor of its choice. In some cases, the employer expects this doctor to manage your treatment throughout your recovery. However, that doctor may not be the right fit for you. Fortunately, you have the right to change doctors at any time—even if the employer selected the first provider.

To do so, you must send written notice to both the employer or insurance carrier and the Vermont Department of Labor. Failing to follow this process may result in the employer or carrier refusing to pay for your treatment.

If you hire Jarvis & Modun to represent you in your Vermont workers’ compensation claim, we will make sure the process of switching to your preferred doctor is handled properly and promptly, so you can focus on getting the care you need.

Nurse Case Managers

Employers and insurance carriers sometimes assign Nurse Case Managers (NCMs) to help coordinate an injured worker’s medical care. In many cases, NCMs are very helpful. They may serve as a resource to help you understand your treatment options and assist in expediting your doctor’s recommendations. However, not all NCMs act appropriately. The problematic ones may try to control your medical care, pressure your doctor to release you back to work too soon, or act as field claims adjusters, which is not their role.

At Jarvis & Modun, we believe NCMs should not be present in the examination room during your medical visits. A doctor should be able to focus entirely on you during the exam. The presence of a Nurse Case Manager can be distracting and, in some cases, intimidating—potentially discouraging patients from being open or asking important questions.

If you feel that a Nurse Case Manager has overstepped their role or is not acting in your best interest, call Jarvis & Modun to discuss your situation. We can help.

“Independent” Medical Examiners

There is nothing truly “independent” about an Independent Medical Examination (IME). These examiners are often the hired experts in workers’ compensation and personal injury cases. While some IME doctors provide reasonable and objective opinions, others produce reports that appear detached from the facts and seem tailored to support the employer’s or insurance carrier’s interest in denying benefits.

Your employer or its insurance carrier has the right to send you for an IME to evaluate medical issues related to your claim. However, this right is not unlimited. For example, they cannot use an IME to deny a claim they have already accepted without reservation, nor should they use an IME to revisit medical questions that were already addressed in a previous IME. Unfortunately, these abuses do sometimes occur.

If your benefits have been denied based on an IME report, you should seek legal representation immediately. The Vermont Department of Labor requires that claims involving disputes between medical opinions proceed to a formal hearing—a process similar to a trial where witnesses are sworn in and subject to cross-examination. Employers and insurance carriers are always represented by lawyers at these hearings. Without your own attorney, you face a significant disadvantage.

Put our experience to work for you. If you have been denied benefits because of an Independent Medical Examination, call Craig Jarvis or Amy Modun at (802) 540-1030 for a free consultation.

Preauthorization of Medical Treatment

If a medical provider wants to ensure payment for recommended treatment, Vermont law provides a process for seeking preauthorization from the employer or insurance carrier. The provider must submit a written request along with supporting medical evidence. The employer or carrier then has 14 days to review the request and take one of three actions: authorize the treatment, deny the treatment, or notify the provider that it will conduct a medical review or examination. If the employer or carrier chooses the last option, it has an additional 45 days to complete the review or examination before deciding to approve or deny the request.

Unfortunately, employers and carriers sometimes abuse this process. They may fail to respond within the required timeframe or deny preauthorization without a valid reason. These abuses cause unnecessary delays in care. Too often, injured workers become frustrated and give up pursuing the treatment they need—saving the employer or carrier money at the expense of the worker’s health.

Don’t give up. If you are having trouble obtaining necessary medical treatment, call Jarvis & Modun. We fight to secure the care our clients need.

Denials of Treatment or Medication

Whenever an employer or insurance carrier denies payment for treatment or medication, they must provide a reasonable basis for the denial. They cannot simply refuse payment because they disagree with the treatment or medication prescribed. In most cases, they must support their denial with a medical opinion stating that the treatment or medication is not reasonable, necessary, or related to work.

Remember, neither your employer nor its insurance carrier is a medical professional. Their mere belief that a treatment or medication is unreasonable or unrelated to work does not qualify as a valid medical opinion. Yet, they sometimes attempt to deny medical bills without proper medical justification.

If your employer or carrier has denied payment for a medical bill, contact Jarvis & Modun. We are committed to ensuring your doctors are paid so they can continue providing the treatment you need.

Letters to Doctors

Sometimes an employer or insurance carrier tries to control your medical treatment by directly contacting your treating doctor. In Vermont, when a worker files a Workers’ Compensation claim, the employer or carrier is entitled to receive a medical authorization from the worker that allows them to request medical records related to the work injury. In certain cases, they may write to doctors to obtain medical information necessary for adjusting the claim. When this happens, they should always send a copy of the correspondence to both the worker and their attorney.

However, employers and carriers sometimes abuse this medical authorization. They may request records beyond the scope of the authorization or unrelated to the work injury. They may also send inappropriate letters to doctors in an attempt to control or prematurely end treatment.

If your employer or its insurance carrier is writing letters to your doctors, contact Jarvis & Modun. They may be trying to deny you the benefits you deserve.