YOU CAN DENY THE CLAIM WHILE MAINTAINING CONTROL OF THE MEDICAL BENEFITS
The case of Fluor Enterprises, Inc., d/b/a Fluor Signature Services v. Darrell Lawshe was previously reported in this blawg on February 6, 2009. This case put employers, insurers, and third party administrators on notice that they may lose the right to choose the doctor if they deny a claim and it is later determined to be compensable. The dilemma thus becomes...do you deny the claim and risk giving up this important right or do you accept the claim in the hopes that by maintaining control of the medical benefits, you can bring a quick and successful resolution to the claim? Depending on the situation, the best answer may be to do both. There is no reason why you cannot continue to pay for medical treatment while, at the same time, denying the claim. If the judge ultimately rules that the claim is not compensable, then you will owe no future medical benefits. If the judge deems the claim compensable, then you have protected your right to choose the doctor.