by Michael A. Winston, Esq.

To kick off the seminar, Chairman Frank McKay shared recent proposals from the legislative advisory council. Of significance to employers and insurers is the proposed modification of the WC-205 Medical Authorization process.

Currently under Rule 205, if an adjuster does not respond to an authorized treating physician’s WC-205 request for a particular treatment within five days, the treatment or testing stands “pre-approved.” However, many healthcare providers are reluctant to proceed with the treatment (often surgery) without explicit approval due to concerns about getting paid. This often results in the claimant filing a hearing request for authorization of the recommended treatment. A new process is being considered to simplify matters and takes the approach of a “show cause petition.” On the proposed new form, which may not even be called a WC-205, the adjuster would either check a box approving the request, or check a box denying the request. If denied, or if there is no response within five days, the employer/insurer may be required to “show cause” for denying the physician’s request.

At this point, the new process has only been proposed and is not in effect yet, but we will keep you updated on this issue since it will require increased attention and efficient response on the part of the employer/insurer.