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New Medical Treatment Delay Tactics

You need to get medical treatment quickly for your work injury.  Georgia changed its workers’ compensation law a few years ago.  This change placed a limit on an insurance company’s responsibility for medical treatment in a workers’ compensation case.  Now, insurance companies only have to pay for medical treatment for 400 weeks from the date of a work injury.

Unfortunately, this change in the law encourages insurance companies to delay and deny your medical treatment.  Now, injured workers may find have more difficulty than ever getting medical treatment approved.  Since many medical providers will not provide medical treatment without “preauthorization” from the insurance company, injured workers often become victims of medical treatment delays:

  • Insurance companies fails to approve physical therapy, injections, diagnostic testing, and surgery
  • Injured workers experience increased pain and possibly permanent disability as a result of waiting for treatment
  • Injured workers may lose their jobs if their leave of absence under FMLA (the Family Medical Leave Act) or other leave of absence expires

Delays in medical treatment can make it difficult to return to workDelay tactics used by insurance companies

Insurance companies have several different tactics they use to delay medical treatment. Some of the tactics used include:

Requesting a “second opinion” before approving treatment

Insurance companies often use this medical treatment delay tactic when your workers’ compensation doctor is requesting approval for surgery. The insurance company will often tell the doctor that they want to get a “second opinion” before approving the surgery.

This tactic often delays approval of surgery by a couple of months. First, the insurance company spends some time getting the second opinion scheduled. Then, the insurance company has to wait for the report from the doctor afterward.

Also, if the second opinion doctor says you do not need surgery, then the insurance company will usually not agree to approve the surgery.  This means you experience more delay.

Failing to return calls or e-mails from the doctor requesting approval

Unfortunately, one of the biggest problems we run into is insurance companies simply not responding to requests for treatment. They do not say “No” to the doctor or other medical provider. They just do nothing for days, weeks, or even months. If the doctor’s office does not want to provide treatment without approval from the insurance company, this can cause a big problem.

Dragging out medical treatment until the 400 weeks runs outPain management construction worker

Now that insurance companies only have to pay for medical treatment for 400 weeks from when an injury occurs in most cases, insurance companies will soon be able to just try to delay treatment until time runs out. As the 400 week deadline approaches, delays by insurance companies could push treatment out past the date that they are responsible.

Also, even before the deadline, delaying your treatment may save the insurance company money. With certain types of treatment that the doctor needs to repeat every so often, each delay by the insurance company will decrease the number of future treatments they pay for as the 400 week deadline approaches.

What can I do to fight these delay tactics?

Fortunately, you can use tactics to try to get your medical treatment approved more quickly. One tactic is to use the Form WC-205 published by the Georgia State Board of Workers’ Compensation.  This form allows a doctor to request preauthorization for treatment and requires the insurance company to provide an answer within 5 business days.  This can be used to fight the tactic of the insurance company just doing nothing.

A second option is to call and/or a-mail the adjuster and request an answer.  This tactic may help focus the adjuster’s attention on your case and will sometimes work.  This could result in the insurance company approving the treatment.  However, this tactic often works better if you hire an attorney.

The Georgia State Board of Workers’ Compensation introduced a third option in July 2017.  You or your attorney can now request a conference call with a workers compensation judge by filing a Form WC-PMT.  This article explains how you can file a Form WC-PMT and how the process works after you file it.

Why might an adjuster authorize medical treatment if I have an attorney?

Because the adjuster knows that the attorney will request a hearing and get a judge to issue an order deciding whether the insurance company has to pay for the medical treatment.

If you do not have an attorney, the adjuster knows that you may just not press the issue. If the delay frustrates you, the adjuster knows you may just go away.

This saves the insurance company money. Even if you do request a hearing, the insurance company will know that they will have an advantage since their attorney will know the rules of workers’ compensation and you will not.

Having an attorney can put pressure on the insurance company.  They know that you will not just go away.  It increases the chance that the insurance company will approve the treatment you need.  Even if they do not, you are more likely to get your medical treatment approved by a judge if you have an attorney who specializes in Georgia workers’ compensation law.

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.

Brittney-lee orourkeBrittney-lee orourke
05:23 18 Feb 22
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!-Brittney
China JonesChina Jones
18:58 08 Feb 22
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.
Luv LocsLuv Locs
16:08 15 Jan 22
The entire law office was attentive and responsive to all of my concerns dealing with my workers compensation case.
21:14 02 Jan 22
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.
Dana BessDana Bess
23:57 10 Dec 21
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.

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Jason Perkins

Workers' Compensation Attorney

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