“When I seek out professional advice, I don’t want B.S. I want it straight up, with no double talk. I figure do also. I always use plain English, with no sugarcoating no B.S lawyer talk, and no double talk- just old fashioned, unsweetened, unvarnished truth-just the way that I would want it.” -Bill Turley
The First Thing You Must Do
Before I get into the step by step guide for denial of benefits, there are a few more steps to ensure you put your best foot forward in your case. The first thing you must do is always tell the truth. No matter what it is you are worried about, you must always be honest and never sugarcoat anything to the judge or you attorney. If you do, then you will lose your case. Trust me, I have seen it time and time again. Do not be that person.
The Next Step
Before you even think about signing any forms from the DBA insurance company, you need to do your research. Order my free book, Win Your Defense Base Act Case: The Ultimate Straight Talk Roadmap To The Medical Treatment and Money You and Your Family Deserve.
It is full of information that will benefit you with your road to recovery and peace of mind after becoming an injured DBA contractor. Read the 5 Star Amazon Reviews written by folks like yourself, trust me, you will thank me later.
Also you can check out my podcast at DBAradio.com where i cover important DBA issues.
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If you need help now, give us at call at (619) 234-2833.
A Step by Step Guide: Defense Base Act Medical Benefits are Denied....
Under the Defense Base Act your employer / carrier is obligated to provide you reasonable medical treatment. All too often the carrier will arbitrarily refuse to pay or stop paying for medical treatment. They will controvert your DBA claim.
One thing is certain - doing nothing is not the best option. If your Defense Base Act medical benefits are denied or the insurance carrier refuses to pay for your medical treatment you need to take action. Now.
1. A Good DBA Attorney
First, you need to hire a good DBA attorney. Which, of course, is easier said than done. If you do, your lawyer should be doing these things.
2. File a LS-203
Second, you need to file a claim for compensation with the US Department of Labor. You will need to file an LS-203. You can obtain the LS-203 from our office or the Department of Labor. Keep a copy for yourself. If you don't hear back from the Department of Labor within a few weeks of filing your claim, follow up in writing.
3. Medical Evidence
Third, you will need medical evidence. To begin with you need proof that you need the medical treatment. Usually it will be your treating physician who prescribed the treatment. You need something from the doctor indicating such. You don't need anything really formal. A letter on the doctor's letter head in the doctor's most legible handwriting can suffice. You can show the doctor this article if you want.
Many doctors will prepare a report for the insurance company. That is great. A typed more formal letter is great also, but some doctors charge for typed written reports. However, you are not in a position to pay for the medical report. In this instance a hand-written report can carry the day. The doctor's "report" should cover some basic points.
The doctor needs to state the treatment is related to your work injury. If the carrier is disputing you have a work related injury the report should describe how you were injured and why it is work related. A short explanation is better than as a conclusion.
The doctor should state why they are recommending the treatment. Finally, the doctor needs to state the treatment is necessary to cure or improve your industrial medical condition.
4. Request treatment be authorized
Fourth, you need to request the carrier to pay for the treatment. This needs to be in writing and you need to have a copy proving this.
5. District Office
Fifth, you need to contact your local District Office of the US Department of Labor. Send them a letter, briefly describing all of the above. Request an "Emergency Informal Conference."
6. Emergency Informal Conference Procedure
Sixth, at the emergency informal conference, calmly and patiently explain all of the foregoing to the Department of Labor Claims Examiner. The employer/ carrier will state their position after you do yours.
7. You really need a lawyer
Seventh, representing yourself should be your last and only resort. You need to find a good DBA / Longshore Act attorney to represent you. As the claimant, your credibility is always at issue. When you represent yourself you can unknowingly sabotage your case. Happens all the time. Do yourself a favor - get a good DBA/ Longshore Act lawyer. Even if you don't end up hiring us, we will help you find a good home. Don't end up with a lawyer that has never practiced before the US Department of Labor. Don't be afraid to ask how many Longshore Act trials they have done. You don't want a rookie.
Disclaimer: Please understand these discussions and/or examples are not legal advice. All legal situations are different. This testimonial, endorsement and/or discussion does not constitute a guarantee, warranty, or prediction regarding the outcome of your legal matter, your particular case/ situation and/or this particular case/ situation. Thanks, Bill Turley