Medical dispute process
The medical disputes process has been affected by court decisions, legislative changes, and administrative process changes. Compensability of the underlying medical conditions or the causal relationship between the accepted condition and the medical service are resolved before other medical issues, such as medical services or the appropriateness of treatment, are considered. Once compensability or causality is determined, a case is sent to the Medical Resolution Unit for resolution of the medical service dispute.
In 2008, the alternative dispute resolution (ADR) process was initiated. It has proven effective with medical fee disputes. Medical fee disputes jumped from 28 percent of all medical disputes in 2007 to 63 percent in 2008.
The medical dispute process differs from many of the other dispute processes because the injured worker may not be directly involved in the dispute itself.