Medical treatment and testing can often be the most important benefit provided in a Georgia workers compensation case. To recover from a serious injury, you will need good medical treatment.
Unfortunately, many people find it frustrating to get that medical treatment. There are rules about which doctors can provide treatment and whether you get to choose your doctor. Also, the insurance company may make it more difficult to get the treatment your doctor recommends.
To make sure you get the medical treatment you need, you need to understand these rules. You also need to understand what you or an attorney can do if the insurance company will not approve the medical treatment recommended by your doctor.
Does my employer or their workers compensation insurance company have to pay for my medical treatment?
Yes. Medical treatment is one of the three primary benefits provided by Georgia’s workers’ compensation law. The other two are lost wage benefits (temporary total and temporary partial disability) and permanent impairment benefits (permanent partial disability).
The basic rule about medical is that you are entitled to medical treatment and testing for your injury. You can get treatment that helps heal your injury. You can also get treatment that provides relief from your pain or helps you return to work.
If that were the only rule, getting medical treatment would be easy. Unfortunately, there are other rules that you must follow to get medical treatment paid for by the insurance company. One of these rules is that the workers compensation insurance company only has to pay for treatment with authorized medical providers.
How do I get in to see a doctor after my injury?
If the insurance company only has to pay for medical treatment with authorized medical providers, then you need to know how to select an authorized medical provider. What your employer or the workers compensation insurance company may fail to tell you is that you get to choose who your authorized treating physician is.
Often, your employer will just send you to a certain doctor after you get hurt. They do not tell you that you have a choice under Georgia’s workers compensation law
Your employer should have a panel of physicians posted or should use a WC/MCO. If they follow the rules and do this right, then you will have a choice among at least six different doctors. If they do not follow the rules, you may be able to see whatever doctor you want to treat your injury.
Also, there are ways that you can get your authorized treating physician changed if you become unhappy with the doctor you initially chose. If you want to find out more about changing doctors, this short article provides more detailed information.
What happens when my authorized treating physician recommends additional medical treatment or testing?
When you see your authorized treating physician, they likely will recommend some treatment and/or testing. You would expect that this treatment would happen pretty quickly since the doctor is the expert and the workers compensation insurance company is supposed to pay for the treatment you need.
Unfortunately, it often does not work this way. It can sometimes take weeks or months to get the treatment the doctor recommends. This usually happens because the insurance company does not give authorization to the doctor to perform the treatment or testing.
What can I do if the insurance company will not approve my medical treatment?
If the insurance company is not approving the treatment, you or an attorney may need to take action to get your treatment approved. You may need to contact the adjuster and convince them to approve the treatment.
If the adjuster cannot be persuaded, you or an attorney can take other steps. Some of the steps that can be effective in getting medical treatment approved include:
- Submitting a Form WC-205
- Submitting a Form WC-PMT
- Filing a motion with a workers compensation judge
- Requesting a hearing with a workers compensation judge
These four steps can be difficult to do if you do not have a workers compensation attorney involved in your case. You probably should schedule a consultation to discuss your case with a workers compensation attorney if you reach this point since there are some specific rules you need to follow to make sure the treatment gets approved.
