Your doctor ordered an MRI to diagnose your injury. But, the workers compensation insurance company has not authorized the MRI.
So, you are stuck in limbo because you cannot get better until the doctor can get the test and diagnose your injury. What do you?
Unfortunately, I hear about these problems much more often than I used to. It seems like insurance companies make it more difficult to get what should be relatively simple treatment or testing for your injury. This article will discuss some of the reasons that MRIs and other testing gets delayed and what you can do about it.
What is an MRI?
MRI is an abbreviation for Magnetic Resonance Imaging. It is a test ordered by a doctor to get a better internal picture a particular part of your body.
In workers’ compensation cases, doctors often order MRIs to determine how badly you have been injured
- MRIs on your back or your neck help doctors determine whether you have suffered a herniated disc or pinched nerve
- Shoulder MRIs help doctors diagnose rotator cuff and ligament tears and other shoulder injury
- Knee MRIs can show a torn anterior cruciate ligament (ACL) or a torn meniscus, among other things.
If my doctor says I need an MRI, why does it not get approved?
Unfortunately, your doctor ordering the MRI does not always mean that it is going to happen quickly in a Georgia workers compensation case. Most MRI testing facilities will want the insurance company to approve the MRI before they schedule an appointment for you.
Sometimes, the doctor orders the MRI and you receive a call a few days later that it has been scheduled. But, the MRI will probably not get scheduled if the insurance company does not approve it.
This can be very frustrating. You just want to get the test you need so you can get better.Why is this delay happening?
Several things can cause this delay:
- The workers compensation coordinator at the doctor’s office or MRI testing facility cannot get an answer from the insurance adjuster
- The insurance adjuster says that they need time to “review the file” before making a decision about approving the MRI
- The insurance company wants a second opinion before approving the MRI
- The MRI is denied by the insurance adjuster
- The insurance adjuster sends the MRI request to utilization review
All you may know is that the doctor said you need an MRI and the MRI has not been scheduled yet. You do not know why the MRI has not happened unless you or your lawyer does some research.
What can I do to get the MRI approved?
Delay and denial of medical treatment is a serious problem in many Georgia workers compensation claims. You would like to get the treatment you need as quickly as possible so that you can get out of pain and move on with your life.
You may have to do some things and step in to try to get the MRI approved. A good first step is to contact the doctor’s office or the facility where the MRIs going to be performed. They should be able to tell you what the status of scheduling the MRI is.
If they indicate that they are waiting on approval, try to find out what has been done so far to get approval. If the MRI is not being approved because the adjuster is delaying things, then you may need to contact the adjuster directly.
If you have a lawyer representing you, then that lawyer should take care of that for you. But, you may need to let your attorney know that the MRI has been ordered but has not been scheduled yet.
What if the adjuster still does not approve my MRI?
If you have a lawyer, talk to them to find out the best strategy for getting the MRI approve. If you do not have a lawyer attorney, you can take additional steps to get the MRI approved. Some of your options include:
- Getting the doctor to send a Form WC-205
- Filing a Form WC-PMT
- Requesting a hearing in front of a workers compensation judge
While you can try to take these steps yourself, I would certainly recommend talking to a lawyer if you reach this point. There are special rules and procedures that you need to follow under Georgia’s workers compensation law. A lawyer could be helpful to you in making sure you follow those rules.
Even if you do not think you will hire a lawyer, you may want to talk to one. Our law firm provides free consultations in workers compensation claims. This gives you an opportunity to get your questions answered so you can make a decision about the best way to pursue your case.
If you want to find out more about free consultations, just read this short article that explains the consultation process in more detail. To set one up, just call our office at (770) 214-8885 or complete and submit this consultation request form.