Petition For Medical Treatment {WC-PMT}

WC-PMT - PETITION FOR MEDICAL TREATMENT. This form provides a process for injured claimants to request a conference call with an administrative law judge (ALJ) to seek authorization for medical treatment or testing recommended by an authorized medical provider. Key points regarding this process include: • The claimant must provide the medical request to the employer/insurer at least five business days before requesting a conference call (PMT). • Upon receiving the form, the Board schedules a conference call with an ALJ and notifies all parties with a Notice of Telephonic Conference. • The employer/insurer has the option to reply to the PMT, either authorizing or denying the requested treatment. If denied, they must provide a reason for the denial (controvert). • If the employer/insurer authorizes or controverts the treatment, the conference call is canceled. • If the employer/insurer requires more information before making a decision, both parties must participate in the conference call with the ALJ to address why the treatment has not been authorized. • During the conference call, the ALJ may either deny or authorize the requested treatment. If authorized against the employer/insurer's objection, they must file a WC14 Request for Hearing within 20 days. Failure to do so implies consent to payment as per the fee schedule for the treatment/testing. www.FormsWorkflow.com