Prior authorization for accidental or work-related injuries

If the referred condition is from an accident or work-related injury, complete the appropriate area of the Accident and injury incident questionnaire (PDF) with as much information as possible, including any event-specific information.

When you submit a prior authorization request for a work-related accident, Kaiser Permanente will deny the authorization for coverage because the member's Medical Coverage Agreement does not cover these services. Regardless, it is always best to submit a prior authorization request so that it will be on file in case the workers' compensation carrier denies the claim. If the claim is not accepted by the worker's compensation carrier, Kaiser Permanente can then review the original request for coverage of services.

Note: Kaiser Permanente may not cover the service if the care for the injury is provided by a noncontracted practitioner or vendor.

For work-related injuries, submit claims directly to the designated workers' compensation carrier identified by your patient.

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