It is frustrating to hear that your workers’ compensation claim is not authorized when you have work injuries.
If your employer’s insurance company denied your medical treatment request, the laws in Georgia give you the right to appeal the decision.
Why was your claim denied?
On-the-job injuries can result in significant medical expenses, lost work time and rehabilitation needs. You may require prescriptions, ongoing physical therapy or surgeries. Insurance companies aim to protect their interests and may deny your claim for many reasons:
- The accident occurred while you were on a break
- You did not file a report with your employer within 30 days
- Your injury resulted from reckless behavior or failure to abide by safety rules
- The injury was caused by intentional harm by you or another person
How do you deal with a workers’ comp decision denying medical?
First, file your notice of claim with the Georgia State Board of Workers’ Compensation. You have one year from the date of your injury to do this, although it is best to act as soon as possible. Then, you will either attend a hearing or mediation. If your claim has been approved by the workers’ compensation insurer, but they are refusing to authorize treatment from your treating medical provider, you may file a PMT motion seeking authorization for the medical or file a hearing request.
The PMT motion will result in a quicker decision, but the law allows several options for the workers’ compensation insurer to appeal a decision from the motion. A hearing transpires before an administrative law judge in the county where your accident happened. Mediation involves you and the insurance agency meeting before a mediator to negotiate a solution.
Do you have any options if a judge denies your request for authorization of medical treatment?
If your appeal is unsuccessful, you may file an additional appeal within 20 days. However, this is only possible if you believe there was a mistake during the hearing.
The laws, rules and deadlines regarding an appeals process can be confusing. It is essential to understand the procedures and requirements to argue your case effectively. If your employer’s insurance denies your initial claim, do not give up. You have legal options to seek benefits for your treatment.