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New Medical Treatment Delay Tactics

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

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 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.

Pain management construction worker

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.

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

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