Submitting a Variance Request
If a treating medical provider determines that medical care which varies from the Medical Treatment Guidelines (MTG) a variance request will need to be submitted. For example, when a treatment, procedure, or test was not originally recommended by the MTG but has become appropriate for the injured worker, he or she can then have a variance submitted to the insurance carrier or Special Fund, the Workers’ Compensation Board, or order of the Chair prior to medical care which varies from the MTG can be provided.
This in turn places the burden of proof to establish that a variance is medically necessary or appropriate on the shoulders of the Treating Medical Provider who is making the request.
A Treating Medical Provider who is requesting a variance is required to submit the request in the format prescribed by the Chair to the insurance carrier or Special Fund, Board, claimant, as well as the claimant’s legal team. It is ideal and preferred for the request to be sent to each on the same day, it is required to be submitted no later than two days after it is prepared and signed.
For all variances, there are requirements which must be met. These requirements include:
- A medical opinion from the Treating Medical Provider which includes the basis for the opinion that the proposed medical care that varies from the MTG is appropriate for the injured worker.
- A statement that shows the worker’s agreement to the proposed medical care.
- As well as an explanation of why alternatives under the MTG are either not appropriate or sufficient for the road to recovery.
Additionally, where appropriate, claims may include:
- A description of signs or symptoms which show improvements have not been made with the previous treatments provided in accordance to the MTG.
- Should the variance involve frequency or duration of a particular treatment, a description of the functional outcome, as of the date of the variance request, has continued to demonstrate objective improvement from the treatment and is reasonably expected to continue improving with the additional treatment.
When it comes to submitting a variance request, this is merely the tip of the iceberg. This is not something you need to face; our attorneys are ready to help you navigate the procedures and processes you will face throughout your workers’ comp case.