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
Delay 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 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 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.