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Can Workers Compensation Deny My Medical Treatment?

I talk to many people who have suffered injuries at work.  Many people who call me have had problems getting the workers compensation medical treatment they need.

Often, the workers compensation insurance company has denied some or all of the medical treatment that has been ordered by their doctor.  This is very frustrating because these denials delay their recoveries from their injuries.

Medical treatment is one of the primary benefits provided when you suffer an injury at work. Basically, Georgia’s workers compensation law requires the insurance company to pay for the medical treatment and testing that you need for your work injury.

Among other things, the insurance company has to pay for:Physical therapist neck injury crutches

  • Doctor’s visits
  • Medication
  • Physical therapy
  • Diagnostic testing (x-rays, MRIs, etc.)
  • Injections
  • Surgery
  • Referrals to specialists

Essentially, the insurance company has to pay for any medical treatment and testing you need as a result of your injury at work.  That being said, you need to know that Georgia’s workers compensation law has special rules about who can provide that medical treatment.  You can learn more about those special rules here.

What does denial of medical treatment mean?

For denial of medical treatment to happen, a medical provider must first recommend some type of treatment.  This usually happens when you go in to to see the doctor.

The doctor will discuss what happened to you and examine you.  After evaluating you, the doctor will often recommend some treatment and testing.

When most doctors recommend workers compensation medical treatment, they want to know they will get paid for the treatment.  So, the doctor’s office calls the workers compensation insurance adjuster to ask for approval for treatment or testing.

At this point, a denial of medical treatment by the insurance company can happen a few different ways:

  1. The insurance company files a Form WC-3 Notice to Controvert which denies medical treatment.
  2. The doctor’s office calls or emails the insurance company to ask for approval for a certain medical procedure or test, and the insurance company tells the doctor’s office that the treatment is denied
  3. The doctor’s office asks for approval, and the insurance company provides absolutely no answer in response.  In other words, they “deny” the treatment simply by not giving an answer.

If the doctor’s office does not receive approval, the doctor probably will not perform the recommended treatment or testing.  This means that you suffer additional pain while you have to wait for approval of the treatment.

Why does the insurance company deny medical treatment?

It depends.  An insurance company may deny medical treatment because they believe it is unnecessary.  They may deny treatment on the basis that it is provided by an unauthorized medical provider.

In my opinion, the most common reason insurance companies deny medical treatment is simply because they can.  When they deny medical treatment, insurance companies often do not face any consequences.

Many people do not know what to do to get the insurance company to pay for treatment.  Some people just give up which means they do not get the treatment they need.

Essentially, the insurance company wins when this happens because they do not have to pay for the treatment.  This is not fair because the insurance company’s job is to pay for the medical treatment and testing you need as a result of your injury.

How can I make sure I get the medical treatment I need for my injury?

Worried couple looking at billsYou have to figure out a way to get the insurance company to approve the treatment with the doctor.  Here are a few ways you may succeed in getting the treatment approved:

Unfortunately, getting the insurance adjuster on the phone can often be difficult.  Even when you get them on the phone, getting them to contact the doctors office and provide approval can be difficult as well.

I solve most of my client’s medical treatment delay issues now with filing a Form WC-PMT.  While the WC-PMT process usually works well to get medical treatment approved, there are a number of specialized rules that you have to follow to use that process successfully.

Denial and delay of medical treatment can cause extreme frustration.  Unfortunately, Georgia’s workers compensation system often makes it difficult to do if you do not have someone on your side helping you out.  You may need to talk to an attorney about the issues you have getting medical treatment.

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.

It took me probably too long to finally get a lawyer when my work comp claim started and I had no idea what I should do. I read reviews and upon recommendation of several people started the process of getting a lawyer. I am fortunate and lucky to have come across Perkins Studdard. Jason and his team has taken care of me since the moment I first called them and made sure any and all questions I had were answered as well as working hard to get me my settlement so I can continue receiving treatment. If you're looking for a good law firm to represent you in your worker's compensation case I would highly highly recommend this one.Autumn Fields
I highly recommend Perkins Law Firm. Throughout the whole process Perkins team kept me updated and explained everything very well. I am very pleased with their work. You will not be disappointed!!trina flornce
Mr. Perkins and team...Tina* they have all been so awesome. Always available to talk to me with any concerns. Kept me informed on my case all the way. Greatly appreciated!Missy Cherry
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! -BrittneyBrittney-lee orourke
This law firm is very good at what it does the staff and the lawyer's that were involved with my case all were very perfesional and curious I couldn't ask for a better law firm I want to thank everyone for a great job thanks Les RyanLeslie Ryan
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.China Jones
The entire law office was attentive and responsive to all of my concerns dealing with my workers compensation case.Luv Locs
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.moombi
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.Dana Bess
Great staff and very knowlegable. They treat you like family and work hard to get you what you need. Highly recommended.Josh Carter

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Jason Perkins

Workers' Compensation Attorney

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