By: Sarah Hegener, Esq.
By now, you may have had a Petition for Medical Treatment (PMT) call on one of your files. This new medical authorization process was implemented by the State Board of Workers’ Compensation in July 2017 to assist with expedited authorization for medical treatment recommended by an authorized treating physician (ATP) and has been an increasingly popular tool used by claimant’s attorneys in the past year. According to a discussion at this year’s seminar, and our own experience in handling these requests, not all claimant’s attorneys understand the purpose of the PMT process or how it works.
The PMT is fairly limited in scope. It may only be used when the underlying claim has been determined to be compensable, the parties agree upon the ATP and the ATP has recommended medical testing or treatment. In such circumstances, if there has been no authorization within 5 days, the claimant or claimant’s attorney may file the WC-PMT form with the State Board requesting authorization for such treatment. The form is typically used when the claimant is requesting authorization for routine treatment such as physical therapy, prescription medications, or injections. However, the PMT can also be used to request authorization of more extensive treatment, such as surgery. If the employer/insurer needs to investigate the need for the recommended treatment, particularly more extensive treatment such as surgery, the employer/insurer needs to respond to the PMT request and indicate this in their response.
Once a claimant files a PMT with the State Board, the Board sets a telephone conference before an administrative law judge within five business days, at which the employer/insurer will have an opportunity explain to the judge why the requested treatment has not been authorized. At the end of the conference, the judge will issue an order either authorizing or denying the requested treatment. In lieu of participating in the telephone conference, the employer/insurer may file a response to the PMT either authorizing or controverting the requested treatment.
Since the implementation of the PMT, the Board has received nearly 1300 PMT filings. The general results show a treatment authorization rate of around 60% and a controvert rate of 30%. These numbers reflect that the intended purpose of the PMT, which is to expedite authorization of medical care, is being achieved by the PMT process.