An employee who suffers an injury while working needs proper medical care and assistance to recover fully.
However, several injured employees in Georgia were denied the much-needed surgery. Most of the time, insurance companies refuse to shoulder the surgery that the workers’ compensation doctor recommended. This situation adds more frustration to what the injured workers are already experiencing.
Keep reading if you have no idea what to do if your workers’ compensation isn’t approved.
One thing to remember here is that a workers’ compensation attorney can fight for the medical assistance you need to recover. For more information about this, visit company website.
What Are Workers’ Compensation For?
Workers’ compensation provides medical care and financial assistance to employees who suffered work-related injuries. This covers the costs of the surgical procedure as well as pre- and post-operative care, medications, and other medical expenses. Also included in the compensation is a partial wage replacement while the employee is recovering.
But most injured workers aren’t aware of their rights and the steps they need to take if they’ve been denied surgery unfairly.
Why Do Workers’ Compensation Surgery Get Denied?
Insurance adjusters represent and oversee workers’ compensation claims. They are the ones who decide whether to approve or deny your surgery.
Since surgical treatments are expensive, some insurance companies deny the doctor’s recommendation to minimize settlements.
Insurers might deny surgery requests due to various reasons such as:
- The doctor isn’t on the employer’s list of approved physicians.
- The injury or illness isn’t work-related.
- The maximum medical improvement (MMI) of the patient has been reached.
- There is a better medical alternative than surgery.
- The injury worsened as the patient didn’t follow the doctor’s medical treatment plan.
- The insurer doesn’t believe that the worker needs surgery.
- The company didn’t file the claim before the deadline.
- The employees’ pre-existing condition causes the injury.
What To Do When Surgery Is Denied?
When your doctor has diagnosed your injury or illness and recommends surgery, you want to get the procedure done to recover. Unfortunately, the insurance company refuses and denies your approval for surgery.
The best thing to do is to respond effectively. You can appeal by taking steps to get the treatment you need.
Obtain medical evidence.
Submit all medical records, diagnostic tests, doctor’s request for surgery, and other relevant documents to support your claim that you need surgical treatment.
Your personal injury attorney will fight to challenge the denial of surgery and help prove that your injury deserves coverage under workers’ compensation.
Request reconsideration.
Contact the insurance adjuster again to discuss the need for surgical treatment. You may need to submit other relevant documents. The insurance adjuster might also request a second opinion with another doctor before approving the surgery.
File forms WC-PMT or WC-205.
When you can’t get the insurance adjuster to change their mind, use relevant forms to file an appeal.
Your workers’ compensation doctor can use Form WC-205 (the old State Board of Workers’ Compensation form) or Form WC-PMT (Petition for Medical Treatment) to request approval for medical treatment.
A lawyer will help you understand which form you may need to file.
Schedule Time With A Worker’s Compensation Attorney
Remember that denied treatment isn’t the end.
When injured, the most important thing is getting the medical treatment you need. Understand that you need treatment to prevent complications and speed up your healing process.
It’s daunting to handle the case on your own. It’s best to seek assistance and support from Georgia’s workers’ compensation attorney specializing in the claims of injured workers.
