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Tips for Injured Workers Facing Denied Medical Care

If you have been injured on the job, Georgia law generally requires you to see the doctor chosen by your employer or its insurance company. However, injured workers in Georgia may be denied medical care even when ordered by authorized providers. The insurance company’s chosen doctor can refuse to examine or treat the injured worker. This could lead to the employer or insurance company forcing the employee to see a different doctor.

You may want to see the doctor of your choice. However, employers often provide injured workers with incorrect information on where to go. Georgia law allows an injured worker to receive treatment for a work injury from a preferred medical provider. This is in situations where medical care has been denied by the doctor or the employer/insurance company. 


For example: “Where the claimant has been refused authorized treatment (either by the authorized treating physician or by the employer or its insurer itself) and where the claimant can show that he reasonably required further care despite that refusal, then the claimant is entitled to undertake the care he reasonably requires for his injury with a physician of his own personal selection, at the employer or its insurer’s expense.” Boaz v. K-Mart Corp., 254 Ga. 707, 334 S.E.2d 167 (1985) (finding that the employee had been dismissed from treatment as cured by the company doctor even though still in need of treatment, and where, following the termination of the claimant’s employment, the employer had resisted all claims, including claims for further medical care, on the ground that any present problems were not related to the employment). See also American Mut. Liab. Ins. Co. v. Jordan, 113 Ga. App. 842, 149 S.E.2d 870 (1966) (holding the employer liable for the costs of services rendered by the claimant’s own personal choice of physicians where the claimant was found to still be in need of medical care but where the claimant had nonetheless been dismissed by his authorized physician and advised that he should pay for his own treatment in the future).

Arming yourself with knowledge of the law often is not enough. You need someone to enforce the rights you have under Georgia Workers Compensation law. Employers and Insurers often take advantage of unrepresented employees when it comes to medical and lost wage benefits. Hire experienced and knowledgeable attorney T. Andrew Miller to argue these points of law for you and guide you through the claim process.

If you’re an injured worker in Georgia who is facing denied workers’ comp medical care in your workers’ compensation claim, you’re not alone. It can be frustrating and overwhelming when the treatment you need to recover from a work-related injury, like a surgery for example, is denied. However, there are steps you can take to navigate this challenging situation and ensure you receive the care you deserve.

Female doctor woman worker

Understanding Why Workers’ Comp Treatments Are Denied

Before we delve into tips for dealing with denied medical care under workers’ compensation, it’s important to understand why workers’ compensation may deny certain treatments. Common reasons for treatment denials include:

  • Lack of Medical Evidence: Workers’ comp may require substantial medical evidence to support the necessity of a specific treatment or procedure.
  • Disputes over Causation: There might be disagreements regarding whether the injury is directly related to your work.
  • Pre-existing Conditions: Workers’ comp may argue that your injury is related to a pre-existing condition rather than your workplace incident.
  • Failure to Follow Procedures: If you fail to follow prescribed medical procedures or miss appointments, it can lead to treatment denials.

Tips for Navigating Denied Workers’ Comp Medical Care: Why Hiring an Attorney Matters

While the following tips can help you address denied medical care in a workers comp case, it’s essential to emphasize that hiring a workers’ compensation attorney is often the most effective and advisable course of action. Here’s why:

  1. Consult with an Experienced Workers’ Compensation Attorney

One of the first and most crucial steps you should take is to consult with an experienced workers’ compensation attorney. They are well-versed in the complexities of workers’ comp claims and can assess your case with a trained eye. An attorney understands the legal nuances and can identify potential issues with your claim that may have led to treatment denials.

A seasoned attorney will have a deep understanding of Georgia’s workers’ compensation laws and can apply their expertise to your specific situation. They can provide personalized guidance tailored to your case and help you navigate the intricacies of the legal process.

  1. Gather Comprehensive Medical Records

Your attorney can help you gather and organize comprehensive medical records. Having these records readily available and properly documented can significantly strengthen your case when appealing denied treatments. Your attorney will know how to present this evidence effectively.

  1. Request a Second Medical Opinion

Your attorney can guide you in seeking a second medical opinion from another qualified healthcare provider. This independent assessment can provide additional medical evidence supporting the necessity of the denied workers’ compensation treatments. Your attorney will ensure that the opinion aligns with legal requirements.

  1. File an Appeal with Confidence

When your treatments are denied, your attorney can assist you in preparing a strong appeal. They understand the specific legal requirements for appeals and can present your case persuasively, increasing your chances of a favorable outcome.

A well-crafted appeal is crucial when seeking to overturn a denied workers’ compensation claim. Your attorney will not only ensure that all required documentation is submitted but will also articulate the legal arguments supporting the necessity of your treatment.

  1. Stay Compliant with Medical Instructions

Your attorney will emphasize the importance of following your treating physician’s recommendations diligently. This not only aids in your recovery but also prevents potential arguments that you’re not cooperating with medical treatment.

  1. Explore Vocational Rehabilitation with Legal Support

If you are unable to return to your previous job due to your injury, vocational rehabilitation services may be available. Your attorney can help you navigate this process, ensuring you receive the necessary support and resources to retrain for a different position.

Navigating vocational rehabilitation can be complex, and having legal support ensures that you fully understand your rights and options. Your attorney can advocate on your behalf to secure the vocational rehabilitation services you need.

  1. Be Patient and Persistent with Legal Guidance

Dealing with workers’ compensation claims can be time-consuming and frustrating. However, with an experienced attorney by your side, you’ll have the support needed to navigate the process efficiently. Your attorney will keep you informed, guide you through each step, and ensure that you remain patient and persistent in pursuing the care you need.

  1. The Legal Advantage: Why an Attorney Makes the Difference

It’s important to emphasize that hiring a workers’ compensation attorney can make a significant difference in the outcome of your claim. Attorneys who specialize in workers’ compensation cases are equipped with the knowledge and experience needed to navigate the complexities of the legal system effectively.

By working with an attorney, you gain access to their legal expertise, which includes understanding the specific laws and regulations governing workers’ compensation in Georgia. They can interpret these laws in the context of your case and use them to your advantage.

Attorneys are also skilled negotiators. They can engage with insurance companies and opposing parties on your behalf, ensuring that your rights and interests are protected. In cases where settlement negotiations are necessary, an attorney can strive for a fair and just resolution that covers your medical expenses and provides for your future needs.

Workers' compensation lawyer

Give Yourself the Best Chance to Succeed

When your treatments are denied through workers’ compensation, it can be a challenging situation to navigate. While the provided tips are valuable, it’s essential to emphasize that hiring an experienced workers’ compensation attorney is often the best approach. They possess the legal knowledge and experience necessary to advocate for your rights, increasing your chances of receiving the necessary medical care to fully recover.

If you’re facing denied workers’ comp medical care in your workers’ compensation claim in Georgia, The Law Offices of T. Andrew Miller is here to help. Contact us today to schedule a consultation and discuss your case with our experienced workers’ compensation attorneys.

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