The Department of Labor and Industries (L&I) recently made a coverage decision regarding proton beam therapy. Here, the decision is in an L&I claim for cancer and its treatment. An L&I claim for cancer falls under an occupational disease claim. These types of claims arise when work conditions cause a sickness or an illness. For treatment, proton beam therapy delivers high doses of radiation to tumors with limited scatter impact to the surrounding tissues. In fact, this procedure is ideal for treating deep tumors that are close to critical organs and body structures.
What cancer types does L&I cover under my claim?
Recently, L&I decided that proton beam therapy is a coveted treatment for injured workers presenting with certain primary cancers. Interestingly, these kinds of cancers include esophageal cancer and head or neck cancer. They also include skull-based cancer and hepatocellular carcinoma cancer. Moreover, they include 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
Proton beam therapy is not new. In fact, proton beam therapy was under review in 2014 for L&I claims for cancer. After that, the State Health Technology Clinical Committee (HTCC) reviewed it again in May 2019. On re-review, the HTCC expanded the kinds of primary cancer proton beam therapy under this treatment. L&I has adopted the HTCC coverage determination for workers’ compensation claims.
L&I claim for cancer and treatment authorization
Generally, in workers’ compensation claims, proton beam therapy requires prior authorization. For State funded claims, you can complete a pre-authorization form 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.
More information about proton beam therapy in L&I claims and workers’ compensation claims is available on the L&I website.