Understanding Post Award Medical Review and Modification

An employee who suffered an injury and is receiving benefits under the Kansas Workers Compensation Act may undergo changes – injuries may worsen, for instance – or the employer or insurance carrier may suspect that the employee no longer needs the level of benefits they are receiving. In any case, a party can seek a post-award review of medical benefits.

The review will then be held by an administrative law judge (ALJ), who can decide to continue the benefits, modify them, or terminate them. Clearly, if your employer or workers compensation insurance carrier seeks a review, you will need the assistance of an experienced attorney to file your brief and represent you during proceedings if oral arguments are to be held.

Wichita-based Slape & Howard has been fighting for the rights of employees throughout Kansas in light of legislation and regulations that favor the employer and insurance carrier over the injured or ill employee seeking benefits under workers compensation.

Filing for and having claims approved became ever more difficult following the 2011 passage of the Kansas Workers Compensation Act (KWCA), which reduced the time frames for being medically evaluated and submitting claims. It also made it harder for those with pre-existing conditions to qualify for benefits.

Then, to make it harder for physicians to use their discretion and judgment in evaluating medical conditions, the state started using the Sixth Edition of the AMA’s Guide to Permanent Impairment in 2013. The new edition changed the definition of impairment from the inability to perform one’s job to the inability to care for oneself – eating, sleeping, and personal hygiene.

If you’re receiving an award of benefits and would like to have it reviewed because you feel it is inadequate, or worse, your employer or insurance provider has filed for a post-award review, contact us at Slape & Howard immediately, wherever you are in Kansas. We will help you prepare the documentation you need and represent you aggressively to preserve or enhance your benefits.

What Is a Post-Award Medical Review?

Kansas Statute 44-510k states: “At any time after the entry of an award for compensation wherein future medical benefits were awarded, the employee, employer or insurance carrier may make an application for a hearing, in such form as the director may require for the furnishing, termination or modification of medical treatment.”

In other words, any one of the major parties involved in a workers compensation award – employee, employer, or insurance provider – can request a review of the award. 

The employee might make such a request because they feel the award is inadequate or an incomplete or misguided medical evaluation. In contrast, the employer or insurer might request a review because it feels the benefits are too generous or that the employee is not as injured as claimed.

How Is a Post-Award Medical Review Initiated?

The request for a post-award review is initiated in the same manner as requesting any workers compensation decision to be appealed. The request must be filed using the Kansas Department of Labor, Division of Workers Compensation’s electronic filing system known as the Online System for Claims Administration Research/Regulation (OSCAR).

If you as the award recipient retain an attorney, which is highly advised, all pleadings, applications, motions, and other documents under the Workers Compensation Act must also be submitted using OSCAR.

What Happens Next?

After the request is received through OSCAR, a briefing schedule and hearing date notice will be emailed to all parties involved. The appellant – whether employee, employer, or insurer has 30 days to file a brief. The other appellee(s) then have 20 days to respond with their own briefs. In calculating the days, weekends and holidays can be excluded.

The Appeals Board, which receives all requests through OSCAR, will then decide if oral arguments are necessary. If they are deemed so, the arguments will either be held in person or by telephone. If oral arguments are not deemed necessary, the assigned administrative law judge (ALJ) will make a decision based on the briefs, but they may also order a further physical evaluation of the benefits recipient.

The ALJ can then find that the award should be continued if it is “more probably true than not” that “further medical care is required,” or the ALJ can modify or terminate the award if such care is no longer needed or may not have been needed in the first place.

Appealing a Post-Award Decision

According to Kansas Statute 44-501k, “No post-award benefits shall be ordered, modified or terminated without giving all parties to the award the opportunity to present evidence, including taking testimony on any disputed matters.” The Appeals Board will conduct a “full review” before approving, denying, or amending the decision. You and your attorney will thus have an opportunity to challenge any unfavorable ruling.

Workers Compensation Attorneys Serving Employees Throughout Kansas

The workers compensation attorneys at Wichita-based Slape & Howard have been fighting aggressively for the rights of employees to obtain the benefits they justly deserve under Kansas laws and regulations. If you are seeking or are the subject of a post-award medical review, reach out to us immediately.

We will use our experience and resources to help you assemble the documents and medical evidence necessary to press your claim or appeal forward. We know the workers compensation system inside and out and can provide you with the tools needed to claim the benefits you deserve. We proudly serve clients in the state of Kansas.