What can I do if the workers’ comp insurer denies a medical referral from my doctor?

Posted on

What happens if workers’ comp denies your medical referral? Sometimes, for no apparent reason, a workers’ compensation insurance company will decide that a referral for surgery or for additional treatment with another doctor, even when the recommendation or referral came from the workers’ comp authorized treating physician, is not authorized. Often, we see this when the recommendation is for pain management, psychiatric care, or surgery. Instead of allowing the injured worker to see the expert his workers’ comp doctor suggests, the insurance company will want him to go much farther away to a medical provider of its choosing instead.

Do I have to use the workers’ comp medical provider?

Under Georgia Workers’ Compensation Rule 200(b)(2), there are a few factors a court will consider when deciding whether the insurance company’s requested change in doctors is of benefit to the injured worker:

1) proximity of the doctor to the injured worker’s home

2) accessibility of the doctor to the worker

3) excessive/redundant performance of medical procedures previously given

4) necessity for specialized care

5) language barriers

6) referral by the authorized treating physician

7) noncompliance of the doctor with board rules

8) who’s on the panel of physicians

9) duration of treatment without improvement

10) number of prior treating doctors

11) prior requests for changes in treating doctors

12) if the worker was released to regular duty by the authorized treating doctor

13) if the current doctor has nothing more to offer.

What should I do if the workers’ comp adjuster is denying my medical referral?

If your workers’ comp doctor has referred you for treatment with another specialist or at another facility, and the workers’ comp adjuster is denying it or has filed a motion through a defense attorney for a change in physicians to keep you from treating with the doctor to whom you were referred, call our Atlanta workers’ comp lawyers’ office for assistance with filing an objection and/or a hearing request with the State Board of Workers’ Compensation so that you can fight for the medical care your doctor wants you to get instead of the medical care your employer’s insurance company wants you to get.



Get your copy for free:

book image

Get Help Now

678.831.6239 It's Easy to Get Started
Either call or fill out the form below to speak with a dedicated attorney from our team
100% Secure and Confidential