You are entitled to be compensated for all necessary medical care for injuries you suffered at a workplace accident under Georgia’s workers’ compensation laws. Your employer’s insurance company is required to pay for your doctor visits, medications, hospitalizations, surgery, diagnostic tests, referrals to specialists, and more. Unfortunately, the insurance company may deny your request for needed treatments for your injuries.

How Could the Workers’ Compensation Insurance Company Deny Your Claim?

When you are being treated for a workplace injury, your physician will determine what diagnostic tests and treatments you need. He would then contact your workers’ compensation insurance company to ensure that your tests and treatment are approved and will be paid. Unfortunately, the insurance company may deny his request. This denial can take a number of forms:

Actual denial.

They can deny the request outright.

Partial denial.

The insurance company can approve the service but require you to be treated by a different medical provider.

Delay.

The insurance company could delay making a decision on your medical treatment. For example, they could first require you to obtain a second opinion.

Ignore request.

In some cases, the insurance adjuster could simply fail to respond to your doctor’s calls, faxes, or emails.

Steps You Can Take If the Insurance Company Denies Your Medical Treatment

Fortunately, you have options if the workers’ comp insurance company denies your doctor’s request to authorize necessary medical treatment for your injuries. Here is what you should do:

Retain an attorney.

Your first step should be to hire an experienced workers’ compensation attorney as soon as possible. He can take the proper steps to get your treatment approved.

Call insurance adjuster.

Your attorney may be able to call the insurance adjuster and provide any additional information that is needed or to otherwise resolve the dispute about the care you need.

File a Form WC-25.

Your doctor’s office can submit a Form WC-25 if the insurance company refuses to respond to a request for approval of medical care. Under Georgia law, the insurance company has five business days to respond. If they fail to do so, the request is considered approved.

File a Form WC-PMT.

Your lawyer can file a Form WC-PMT to request a telephone conference with a workers’ compensation administrative judge to obtain a decision on whether your medical treatment should be approved.

Request a hearing.

Another option your attorney has is to file a request for a hearing with an administrative judge. At this hearing, he can present arguments and evidence as to why the insurance company’s denial is not reasonable.

Have You Been Injured At Your Georgia Job?

Are you having problems getting the insurance company to pay for your medical care? Our experienced workers compensation attorneys can answer your question and take the next steps so that your treatment is approved. We can also ensure that you receive the other workers’ compensation benefits you deserve. Please contact us online or call our office directly at 706.863.6600 to schedule a free consultation today.

Christopher J. Hudson
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Local Augusta lawyer specializing in mass tort workers' comp, car accident and personal injury claims.

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