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Getting Medical Treatment for Workers Compensation Back Injuries

Most people never expect that they would have to deal with a workers compensation back injury.  It can be very confusing when you are suddenly in pain and unable to do your job.

You want to make sure that you get good medical treatment to get better.  Your employer or their insurance company has probably told you that you have to go to certain doctors.

You may not know what rights you have.  What rights you have regarding medical treatment is very important to know.  This article will provide some information about how Georgia’s workers compensation law covers medical treatment for back injuries and what you may need to do to make sure you get the treatment you need.

If you want more comprehensive information about workers compensation back injuries, you can also check out this new article which discusses what back injuries are covered under workers compensation and what benefits you should receive for a back injury.

Male doctor shows female patient xray of spine and backDoes Georgia workers compensation cover medical treatment for back injuries?

Yes.  Medical benefits are one of the three basic benefits provided by Georgia’s workers compensation law.  The other two are wage loss benefits (temporary total and temporary partial disability) and permanent partial disability benefits.

Medical benefits under workers compensation pay for the medical treatment and testing you need because of your injury.  Workers compensation covers 100 percent of the cost of that medical treatment.  This means you do not have to pay copays or deductibles.

But, there are certain rules that you must follow to make sure the workers compensation insurance company has to pay for your medical treatment.  If you do not follow these rules, then the insurance company will not to have to pay the cost of the medical treatment.

What are some of the common types of medical treatment and testing that I will need?

The treatment and testing that you need will depend on the type of back injury you have.  Some common back injuries include:

  • Herniated discs (also often referred to as bulging discs or pinched nerves)
  • Spinal fractures
  • Sprains and strains

Doctors refer to your low back as your lumbar spine or lumbosacral spine.  They refer to your mid back as your thoracic spine and your upper back/neck as your cervical spine.  All the back injuries mentioned above could occur in any of these parts of your back.  So, you may see medical records talking about a thoracic sprain, a lumbar spinal fracture, or a cervical herniated disc.

Most back injuries will start with the doctor recommending x-rays or some other type of diagnostic testing like a CT scan.  Your treatment afterward will depend on the results to this testing.

If the doctor thinks that your back injury can be treated conservatively while they evaluate it, the doctor may prescribe medications and physical therapy.  If the testing shows an injury that needs to be addressed more immediately, the doctor could recommend surgery or some other more aggressive treatment.

Even when the doctor recommends conservative treatment initially, you may need more detailed testing later if your injury does not get better.  It is very common for doctors to recommend an MRI if you continue to experience back pain.

This MRI can provide the doctor with a more detailed picture of some areas of your back.  If the MRI shows a herniated disc or some other injury which causes pain, the doctor will probably recommend additional treatment.

What problems could I encounter getting medical treatment for my back injury?

The two biggest problems people run into getting treatment for a back injury are delay and denial.  Most medical offices want to know that they will be paid for the treatment they perform.  Because of this, they often want the insurance company to provide them with approval or authorization before you actually get the treatment they recommend.

This causes a problem for you because you have to wait to get treatment until the insurance company gives the doctor approval.  When you cannot get the treatment you need, your injury will probably not get better and could very likely get worse.  This can be a serious problem when  you have a severe back injury.

Woman suffering from hip and back pain while bendingAre there Georgia workers compensation rules that I can use to help me get medical treatment?

Georgia does have some workers compensation rules that are intended to help get medical treatment approved.  The primary Georgia workers compensation rule that helps get medical treatment approved more quickly is Board Rule 205.

This rule provides a couple of different methods for getting medical treatment approval more quickly.  The first is called a Form WC-205.  The doctor’s office can use this form to request preauthorization for medical treatment from the insurance company.

The second method for approval of medical treatment was introduced in 2017.  That method is called a Form WC-PMT.  It allows you to request a conference call with a workers compensation administrative law judge to try to get the judge to order the medical treatment recommended by the doctor.

Some other ways to get medical treatment approved include contacting the insurance company adjuster and requesting a hearing.  The best method to use will depend on the particular facts of your case.

Can a Georgia workers compensation attorney help me get medical treatment?

A workers compensation attorney can often help you get medical treatment approved.  I handle medical treatment approval issues almost every day including contacting insurance adjusters, filing Form WC-PMTs, and requesting hearings to get medical treatment approved.

The reason I have to do this is that delay and denial of medical treatment has become such a big issue in workers compensation cases.  Often, I am able to speed things up for my clients so they can get the medical treatment they need.

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.

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Jason Perkins

Workers' Compensation Attorney

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