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How Can I Get Workers Comp Medical Treatment Approved?

One of the most surprising problems many people encounter in workers compensation is difficulty getting the medical treatment they need.  Medical treatment for your injury is one of the main things that workers compensations is supposed to cover.  But, many people have difficulty getting the treatment their doctor recommends.

Your workers compensation doctor recommends treatment for your injury.  This treatment may be physical therapy, an MRI, some medication injections or surgery.  Unfortunately, and the insurance company does not necessarily approve that treatment.

When the insurance company does not give the doctor approval for that treatment, then the treatment is probably not going to happen because the doctors office wants to know that they are going to get paid. Not getting the treatment you need can be very frustrating.  You probably want to be able to get treatment and get better.

Male doctor writing a prescription or an order for a test or a referral How do you get treatment approved when the insurance company is not approving it?

There are a few different ways that you can try to do this:

  1. Contact the insurance company and speak with your adjuster or case manager
  2. Filing a Form WC-PMT
  3. Get your doctor to file a Form WC-205
  4. Filing a motion or requesting a hearing

Contacting the adjuster

The adjuster is the person who makes decisions about your case for the workers compensation insurance company.  Your doctor usually will try to get approval from the adjuster for the medical treatment and testing that you need.  But, you can try to get approval as well or have your attorney work to get approval if you hire an attorney.

Most doctors offices want to receive approval for the treatment from the adjuster.  Sometimes, an adjuster just needs to receive certain information to approve the treatment.  I often talk to adjusters to find out what information they need to approve the treatment my clients need.

Filing a Form WC-PMT

Unfortunately, talking to the adjuster is not enough.  The adjuster may still not approve the recommended medical treatment.  Fortunately, you or an attorney representing you can take other steps to get medical treatment approved.

The Form WC-PMT is one way to do this.  This form was created to get an answer about approval of medical treatment when the insurance company is not giving an answer.

You can file the form to ask the insurance company to make a decision about approving medical treatment.  If no decision is made, a phone call is scheduled with a workers compensation judge where the insurance company has to explain why they are not approving the medical treatment that has been requested.  The Form WC-PMT can be a helpful way for you or your attorney to use in moving forward and getting medical treatment approved.

Woman suffering from neck pain Filing a Form WC-205

The Georgia State Board of Workers’ Compensation has another form to help get approval for medical treatment.  The Form WC-205 was created to allow doctors to request approval for the treatment they recommend and to require the insurance company give an answer.

The insurance company is given five business days to respond to that form and either approve the treatment or deny it.  If you or an attorney can get the doctor’s office to file the Form WC-205, this is an additional way that you can move forward with getting treatment approved if your doctor is willing to send that Form WC-205.

Filing a motion or requesting a hearing

A final way to get treatment approved is filing a motion or requesting a hearing. If you proceed with either of these ways, then a workers compensation judge will make a decision about your medical treatment and whether the insurance company should pay for it.

If you go the motion route:

  • You or your attorney will file a motion,
  • The insurance company gets a chance to object, and
  • A judge will make a decision.

If you go the route of requesting a hearing:

  • A hearing will be scheduled in front of a workers compensation judge,
  • You or your attorney will have an opportunity to present evidence at the hearing that basically explains why your treatment should be approved,
  • The insurance company will also have an opportunity to present evidence at the hearing, and
  • The judge will make a decision at the end of that hearing.

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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