If the Medical Treatment Guidelines clearly indicate that a certain procedure is not recommended, is a request for a variance appropriate?
It may be. If the treating medical provider can justify using such not-recommended procedure for a particular claimant in a particular situation, a variance is the appropriate manner to request to perform such procedure. The regulations state, “When a treating medical provider determines that medical care that varies from the Guidelines, such as when a treatment, procedure or test is not recommended by the Medical Treatment Guidelines, is appropriate for the claimant, he/she shall request a variance from the insurance carrier or Special Fund”. In addition, “for all variances a medical opinion by the treating medical provider, including the basis for the opinion that the proposed care that varies from the Guidelines, is appropriate for the claimant and medically necessary, and a statement that the claimant agrees to the proposed care, and an explanation of why alternatives under the Medical Treatment Guidelines are not appropriate or sufficient”. • I understand that if a carrier request
Related Questions
- If durable medical equipment is not addressed in the Guidelines, is a variance request required in order for the item to be supplied to the injured worker?
- Can an injured worker voluntarily pay a medical provider for medical treatment that is not recommended in the Medical Treatment Guidelines?
- Can medical providers provide treatment that is not consistent with the Medical Treatment Guidelines without obtaining a variance?
