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How to Handle Delays in Authorizing Medical Treatment

How many times have you gone to the doctor and he/she has recommended treatment only to find that treatment is delayed by the insurance company?  It could be anything from physical therapy to surgery but now you have to wait for the doctor to get authorization or approval.  Sometimes the authorization comes quickly, but what if it doesn’t?  You could be waiting days, weeks or even months to get the treatment recommended by your authorized workers’  compensation doctor and in the meantime, you are still in pain and the healing process is delayed sometimes causing more injury.  One thing you have to remember is that the treatment you get under workers’ compensation is different from the treatment you may have received in the private sector;   the workers’ compensation process can be slow.

Attorney Laura Lanzisera recently spoke at the Atlanta Bar Association luncheon on how to handle the delays in getting medical treatment authorized for injured workers. http://www.atlantabar.org/events/EventDetails.aspx?id=813051&group=

One of the main avenues discussed by Ms. Lanzisera, was the use of expedited conference calls with the Georgia State Board of Workers’ Compensation Administrative Law Judges.  In a compensable claim (which means that the injury was caused by an accident arising from and during the course and scope of employment  in which you are entitled to receive compensation benefits) in which an authorized treating physician has recommended specific treatment, it is not unusual for this treatment to be delayed by the insurance adjuster/opposing counsel.  To remedy this, the State Board of Workers’ Compensation has enacted new rules in which the parties can request a mandatory conference call.  During these conference calls, we can ask the Judge to order medical treatment.  The Judge needs to determine if there is any basis for the Employer/Insurer to deny such treatment.

Another method to obtain approval of medical treatment for a Georgia workers’ compensation claim is to file a motion with the Administrative Law Judge.  Although the turn around on this method is not as quick as the conference call,  there are times in a case that have specific issues in which evidence needs to be presented for the Judge to review.  While this method is slower, it can be quicker than the last method- requesting a hearing.

Of course, if neither of the previous methods are viable, the claimant through his or her attorney, can file for a hearing with the State Board of Workers’ Compensation.

Many  factors that influence the decision of which avenue to take,  are whether there is any basis for the Employer/Insurer to deny the treatment, whether the medical treatment is reasonable and necessary, and which specific Judge is ruling on the issue.

If your medical treatment has been delayed contact the Law Offices of Laura Lanzisera.  We will work to make sure that you receive all necessary medical treatment for your injury.

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