“Ketamine Therapy for PTSD and Depression: Legal Standards and Coverage Considerations in Alabama Workers’ Compensation”
Swift Currie attorney, Delaney Holmes, authored an article for WorkersCompensation.com discussing legal standards and coverage considerations related to ketamine therapy, PTSD and depression in Alabama Workers’ Compensation claims.
The Alabama Workers' Compensation Act requires employers to provide medical treatment that is reasonably necessary and recommended by an authorized physician,. However, ketamine has not been approved as a treatment by the FDA for patients with PTSD, only depression. Given this limitation and other considerations, employers can challenge or decline treatment that they do not find “reasonably necessary.”
Alabama law has a structured process for challenging employee treatment through utilization review, however, the court will still have ultimate authority at the end of the day to determine medical necessity.
“Coverage determinations are highly fact-specific and require careful evaluation of the medical evidence, including the opinions and recommendations of the authorized treating physicians, as well as applicable statutory and case law standards,” said Holmes. “While no bright-line rule governs the approval of such treatment requests, these considerations collectively form the analytical framework for assessing whether such treatment is reasonable and necessary under the circumstances of each individual claim.”
To view the full article, you may click here.
