You need to get medical treatment quickly for your work injury. When you suffer a serious injury, delays in treatment often affect your ability to get better. Sometimes, these delays can lead to permanent limitations and restrictions.
The State of 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.
Before the change, workers’ compensation insurance companies usually did not have a limit on how long they were responsible for paying for medical treatment for your work injury. Now, insurance companies usually only have to pay for medical treatment for 400 weeks (about seven and a half years) from the date of a work injury.
Unfortunately, this change in the law encourages insurance companies to delay and deny the medical treatment you need to get better. Now, many injured they have more difficulty than ever getting medical treatment approved.
Since many workers’ compensation medical providers will not provide medical treatment without “preauthorization” from the insurance company, injured workers often become victims of medical treatment delays. These delays can lead to some of the following problems:
- Insurance companies fail 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
Delay tactics used by insurance companies
Insurance companies have several different tactics they use to delay medical treatment. Some of the most common 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 at least 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 even more delay because you have to file a motion or go to court to get the treatment you need approved.
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.
The adjuster just does not answer the phone. Whoever calls gets voicemail. The emails sent go into some abyss and never get a response.
If the doctor’s office does not want to provide treatment without approval from the insurance company, this can cause a big problem. You will find yourself stuck and unable to move forward.
Dragging out medical treatment until the 400 weeks runs out
Now that insurance companies only have to pay for medical treatment for 400 weeks from when an injury occurs in most cases, insurance companies can now 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.
This has already happened to some people who suffered injuries shortly after the 400 week law was passed. It will continue to happen to more people as time goes on.
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.
Insurance companies are generally for profit businesses. Workers’ compensation cases costs them money. So, they try to save money on every case so they can make more money. Georgia’s 400 week limit on medical treatment can hurt you because of the ways that insurance companies use it to try to save money.
What can I do to fight these delay tactics?
Fortunately, there are tactics that can be used to get your treatment approved more quickly. One of the most effective tactics that I use is a Georgia State Board of Workers’ Compensation form known as the WC-PMT.
This form allows you or your attorney to request an answer on whether medical treatment is going to be approved or denied. If no answer is given, a conference call with a workers compensation judge is scheduled. This article explains how you can file a Form WC-PMT and how the process works after it is filed.
A second 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. It also requires the insurance company to provide an answer to that request within 5 business days.
The form WC-205 can be used to fight the tactic of the insurance company just doing nothing and to get answers. But, it is often more difficult to use than the WC-PMT form.
A third 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.
Why might an adjuster authorize medical treatment if I hire an attorney?
You can employ some of the tactics mentioned above on your own, but they are often more effective if you have an attorney. The insurance adjuster knows that the attorney will request a hearing and get a judge to issue an order if the adjuster does not approve the needed 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 many people will just give up and go away.
When people give up, it saves the insurance company money. Even if you do not give up and request a hearing on your own, the insurance company will know that they will have an advantage since their attorney will know the special 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. Because of that, it actually increases the chance that the insurance company will approve the treatment you need without you having to go to court. 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 does it cost to hire an attorney?
Many people do not hire attorneys because they get concerned with how much it will cost them. Our law firm handles workers’ compensation case on a contingency fee. That means that you only pay us if we do work to get workers’ compensation benefits to you.
The really great part of that for you is that we do not charge you a fee for getting medical treatment approved under a contingency fee contract. So, many people find it helpful and affordable to get our help in their workers’ compensation cases when the insurance company is delaying or denying medical treatment.