If you have spent time waiting for an Industrial Commission hearing, you might have the opportunity to eavesdrop on conversations between attorneys. A familiar topic is the frustration with what are known as “ADR Hearings” – otherwise known as “alternative dispute resolution hearings.
What is an ADR hearing? In 1993 the Bureau of Workers Compensation delegated its authority to approve or deny medical treatment to third party managed care organizations or “MCOs.” While this was touted as an attempt to streamline authorization it introduced multiple layers of appeals. A cynic might suspect that this was done to discourage injured workers – particularly those who are unrepresented and unfamiliar with the procedure.
Why then is this frustrating for workers’ compensation attorneys? It all boils down to a question of fees. The typical injured worker is represented by an attorney who works on a contingent fee basis – if you get paid, then so does your attorney. ADR hearings do not involve the payment of compensation. They are not, therefore, fee generating.
A shortsighted attorney may be tempted to place a lackluster effort toward these hearings. After all, he or she will not see any direct revenue from the successful outcome. I strongly disagree with this approach. In fact, treatment issues can and do bear a direct impact on future awards compensation – especially PPD or permanent partial disability.
The injured worker should recognize the three issues relevant to any issue involving medical treatment. Are the medical services (1) reasonably related and (2) reasonably necessary for treatment of the injury? (3) Are the costs reasonable? An injured worker should come to their hearing prepared to discuss the beneficial impact of the same or similar treatment in the past.
While the assistance of an attorney can be crucial to securing authorization, it is often the sincere and credible testimony of the injured worker that makes the difference between approval and denial.