When you are hurt on the job, Georgia law says that your employer and their insurance company must pay for emergency care. Further, they must offer you medical treatment with a physician listed on a posted panel of physicians consisting of doctors they have chosen to provide care for work accidents. However, once you are out of immediate danger, the insurance company has the power to authorize or deny the next step in your care – such as diagnostic testing, surgery or physical therapy.
Frequently I get calls from injured workers who are suffering with severe back pain, shoulder pain or even burns, or folks who can’t walk due to knee injuries, but the posted panel doctor will not order an MRI or CT and ongoing medical treatment just grinds to a halt. The posted panel doctor may give you pain medications but his main focus seems to be returning you to work as soon as possible, regardless of your medical issues.
Why would the insurance company refuse to authorize (pay for) diagnostic tests like an MRI or CT scan to find out what is really going on? Don’t they know that the longer a back, shoulder, neck or knee injury remains untreated, the harder it will be for you to recover? Or do they just want you to suffer?
Insurance Companies Save Money by Refusing to Pay for Treatment
My experience has been that the overriding concern of your employer and their insurance company is saving money. If they don’t order that MRI, there will be no medical reason to pay for additional care. If there is no nerve conduction study test, they won’t have to deal with carpal tunnel surgery. Since many insurance adjusters assume you are faking or exaggerating your injury anyway, they figure that eventually you’ll get frustrated and either go back to work, or settle for pennies on the dollar and resign as part of the settlement.
Additionally, the more time that passes after your original injury, the likelihood increases that you may fall at home or have a car accident – then the insurance company can claim that your ongoing pain and limitations arise from some new cause, and not the original work injury. They will use any delay in diagnosis or treatment against you.
Further, Georgia has a 400 week cap on insurance company obligations for non-catastrophic work injuries. 400 weeks (7 1/2 years) seems like a long time but if you find that you need additional medical treatment in year 6, you can bet that the insurance company will find reason to refuse to authorize until the 400 week deadline passes.
During these delays, of course, you have to deal with the pain, inconvenience and reduced or no income. This is why you cannot sit back and wait for the insurance company to do the right thing – you may be waiting for a long time.
Don’t Wait for Insurance Company to Do the Right Thing
The insurance company has the leverage of their checkbook to deny and delay treatment, but you leverage too – Georgia workers’ compensation law empowers us with rights to demand an independent medical evaluation with a doctor of our choice, or to ask a judge to order a change in authorized treating physician.
You deserve to know what is wrong with you following a work accident and you deserve medical treatment to put you on the road to recovery. If your medical condition is not improving or if the posted panel company doctor is not helping, please pick up your phone and call me at 770-351-0801.
