The Department of Labor and Industries (L&I) recently made a coverage decision regarding proton beam therapy. Proton beam therapy delivers high doses of radiation to tumors with limited scatter impact to the surrounding tissues. This makes it ideal for treating deep tumors that are close to critical organs and body structures.
L&I decided that proton beam therapy is a coveted treatment for injured workers presenting with certain primary cancers. These kinds of cancer include: esophageal cancer, head/neck cancer, skull-based cancer, hepatocellular carcinoma cancer, brain cancer, spinal cancer, and ocular cancer. Also, other types of cancers are included when all other treatment options are contraindicated, after review by a multidisciplinary tumor board.
Proton beam therapy was under review in 2014. Thereafter, it was reviewed again in May 2019 by the State Health Technology Clinical Committee (HTCC). On re-review, the HTCC expanded the kinds of primary cancer proton beam therapy can be used to treat. L&I has adopted the HTCC coverage determination for workers’ compensation claims.
Generally, in workers’ compensation claims, proton beam therapy requires prior authorization. For State funded claims, a pre-authorization form can be completed to obtain the necessary authorization. To obtain pre-authorization in a self-insured workers compensation claim, you must go through the employer or their third party administrator.
Ms. Tara Reck is the managing attorney at Reck Law — Workers’ Compensation Attorneys in Washington State. If you would like more information, please contact Ms. Reck through the following:
* Seattle | Bellevue | Mercer Island office: (206) 395–6141
* Tacoma office: (253) 999–9828
* Renton office: (425) 800–8195
* Port Orchard office: (360) 876–4123
* Email: email@example.com
* Her Workers’ Compensation blog at https://tarareck.com/contact/
* or her company website at https://recklaw.com/contact/.
This article first appeared on https://tarareck.com/l-and-i-claim-cancer-treatment/