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Beating Worker Compensation Surgery Delays4 minute read

After weeks or months of treatment, your workers compensation doctor tells you that you need surgery.  That can be frightening because no one wants to have surgery.

If you decide to move forward with the recommended surgery, the doctor’s office should schedule it.  But, that often does not happen in workers compensation cases because the insurance company often fails to approve the surgery recommended by your doctor.

This is extremely frustrating.  You just want to get the treatment your doctor recommended so that you can feel better.  Now, you find yourself stuck waiting for an adjuster to give the doctor’s office the green light before they will move forward with the surgery you need.

Why does the doctor’s office need approval from the insurance company?

Technically, the doctor’s office does not need insurance approval.  The doctor’s office can just perform the surgery and bill the insurance company.  Georgia’s workers compensation laws say that preapproval is not required for medical treatment or testing.

But, this will not happen.  The reason that it will not happen is that the doctor’s office wants to make sure they get paid for the work they do.  So, they will want approval from the insurance company for the surgery before moving forward and performing it.

Doctor examining patient with neck pain

The problem with this approach is that you get stuck in the middle.  The surgery that you need does not get performed until the insurance company gives that approval to the doctor’s office.

This does not make a lot of sense.  After all, the doctor has trained for years to know what medical treatment is appropriate.  The insurance adjuster does not have anything near the medical knowledge that the doctor has.

Unfortunately though, you are stuck in a workers compensation system where the doctors are not going to move forward without insurance company approval.  So, what can you do about this?

How can I make the insurance company approve my workers compensation surgery?

There are several different steps that you can take to get approval for the surgery.

  • Contact the doctor’s office to find out the status of the surgery being approved
  • Communicate with the insurance adjuster to get the adjuster to give the doctor’s office approval for the surgery
  • File a Georgia workers compensation form such as a Form WC-205 or Form WC-PMT
  • File a motion to ask a judge to order the surgery
  • Request a hearing in front of a workers compensation judge regarding the surgery approval

The best step to take will depend on the particular facts of your case.  Sometimes, it will be better to communicate with the doctor’s office or the adjuster.  Other times, it will be better to file a Form WC-PMT or request a hearing.  You may even need to take a multi-pronged approach where you are working on more than one of these things at the same time.

Will hiring an attorney who specializes in workers compensation help get my surgery approved more quickly?

There is a good chance it will.  Unfortunately, I see way too many people who have their treatment delayed for months without even really making any progress toward approval.  An attorney who specializes in workers compensation can help out in several different ways:

  1. Determining which is the best approach to take first to try to get approval
  2. Evaluating if that approach is working and figuring out which approach to take next if that does not work
  3. Knowing how the system works and what needs to be done to get the surgery approved
  4. Understanding the rules that must be followed to be successful when filing workers compensation forms and motions and presenting a case successfully at a workers compensation hearing

This does not mean you have to hire an attorney.  But, I would recommend that you speak with a workers compensation attorney if your surgery is being delayed or denied.

When someone schedules a consultation with me regarding delays in surgery approval, I try to answer their questions and let them know if I believe it would make sense to get me involved in their case.

What if I have other questions about workers compensation?

Georgia’s workers compensation system can be very confusing.  You have to worry about getting the treatment you need and paying your bills while also worrying about not missing any deadlines that could cause you to lose your right to receive workers compensation benefits.

If you have questions, I would recommend that you try to get answers.  To find out more about how to schedule a time to talk to me about your workers compensation questions, just read this short article.

Jason Perkins is an attorney who specializes in representing injured workers.  He regularly publishes videos and write blog articles about Georgia’s workers compensation system and issues that are important to injured workers and their families.

To be notified of Jason’s new workers compensation videos, subscribe to his Georgia Workers Compensation Video Series channel on YouTube by clicking the subscribe button below.

Brittney-lee orourkeBrittney-lee orourke
05:23 18 Feb 22
Amazing! Jason and his team were very helpful and had the best communication by far. Walked me though every step with great detail and had answers for any question I had. They handled my case better then I could imagine, it was a weird case and they stayed on top of it and kept me updated every step of the way! Highly recommend this Team! Thanks so much to Jason and his Awesome team!-Brittney
China JonesChina Jones
18:58 08 Feb 22
I absolutely love this group of attorneys, when I was at my lowest they did everything they could to help me get justice for my injury. I believe if I were to have never picked my phone up and called the amazing group that helped me I definitely would not have received my idea of rights. If you have an issue and are just not sure please understand that they will help you, stay in contact, answer any question you have, and for sure get you the justice you deserve I thank them from the bottom of my heart and I will definitely refer them to anyone who has been hurt because they most definitely care about their work and clients.
Luv LocsLuv Locs
16:08 15 Jan 22
The entire law office was attentive and responsive to all of my concerns dealing with my workers compensation case.
moombimoombi
21:14 02 Jan 22
If you must get a lawyer involved, you’d do well to work with Jason Perkins and his team at Perkins Studdard Law.They were thorough in gathering information and in sharing all the steps in the workers comp process specific to my case. Jason and the team were responsive to my bevy of questions and concerns.I appreciated the informative videos and consultations provided by Jason over video meetings and multiple phone calls.I hope I’m never injured on the job again. However, if I am and if my employer responds as my previous employer did, I’ll contact Perkins Studdard Law immediately to handle the case.
Dana BessDana Bess
23:57 10 Dec 21
Everyone at Perkins Studdard was kind and professional. They were always extremely responsive and answered all questions that I had and followed up to make sure I had an understanding of what was going on along with emailing videos to explain every step of my case so I would know what to expect and be prepared. Jason is a very genuine person and I trusted him with my case. He answered so many questions for me even before I retained him as my WC lawyer. I highly recommend him and his associates at Perkins Studdard.
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Jason Perkins

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