For no particular reason, I’ve been working on a lot of Defense Base Act (DBA) cases lately.  I like these cases–the people are great, the facts are interesting, and the law is pretty good, all things considered (and there are tons of things to consider, which I will try to write about later).  So when I’m working on DBA cases, I’m usually in a pretty good mood.  But today I’m feeling a little cranky because of a new twist that insurance companies are using to deny medical benefits in workers’ comp claims.

And this trick is not limited to DBA claims–state comp carriers are doing it too.  The trick is denying medical benefits based on so-called “Official Disability Guidelines,” or other for-profit publications dressed in “Official” clothing.  But there’s nothing “Official” about “Official Disability Guidelines.”  These “Guidelines” are for sale by the Work Loss Data Institute–a for-profit publishing and database company.  Unless your state has adopted these guidelines into law–and some have done so, but not New Hampshire and not the Longshore and Harbor Workers’ Compensation Act (“LHWCA,” the law that applies in DBA cases)–the “Official Disability Guidelines” are nothing more than a way to make it look like there are agreed-upon rules for how or when various medical procedures ought to be done.  There is no such consensus, and there is no “Official.”  It’s just somebody selling “guidelines” to the insurance industry, which the industry in turn uses to deny benefits in a way that appears principled, instead of arbitrary.

So if you are an injured worker, and your doctor is proposing a treatment that the insurance company refuses to pay for because of the “Official Disability Guidelines,” it might be time to get some advice about your options.

Doug’s post–written by Doug (no ghost writing here).