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Worker's Comp problems in Georgia - delay in care, won't approve benefits Georgia

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  • Worker's Comp problems in Georgia - delay in care, won't approve benefits Georgia

    I was injured in late January, lumbar spine. I went to the Urgent Care facility that my manager advised me to go to. From there it has been a nightmare. They referred me on 2/4 to go to a specialist telling me and the workers comp insurance company that they wanted me to be seen no later than 2/8 by a specialist as I was starting to have nerve pain down my legs. As of yesterday I finally got approval to see a specialist and an appointment for next week. After having threatened to get a lawyer. The urgent care facility won't see me anymore as they state they can do nothing more for me and they have referred me. I have had no treatment, no medication, and no doctor examine me since that time.

    Since that time the pain has greatly increased and sitting/standing for more than a minute or two is very painful in my back, and radiating nerve pain. My supervisor told me she didn't want me at work because every day I work (and spend 9 hours on my feet) I get worse. However, the doctor on 2/4 said I could return to work, not lifting more than 5 lbs. Today the worker's compensation insurance sent me notice that they would greatly reduce my benefits because I was released to go to work on 2/4. I have been calling, emailing, leaving messages, and begging the company to get approved to see a doctor since 2/4. I'm worse, and they want to reduce benefits.

    Is there anyway to fight this? If a doctor states that I should not have been working during this time do they have to retro those benefits? I have never had to use worker's comp and I am totally clueless here.

  • #2
    WC only pays you a portion of your wages if you are taken off work by a doctor or in some cases, if you are released with restrictions but your employer can not offer you work within those restrictions. If you are working, you aren't entitled to those benefits even if it is suggested by a doctor at some later date that you should not have been working. If you aren't working, then you either get those benefits or you don't. There is no partial benefits unless you are working PT or at a reduced wage. It is not dependent upon whether or not you should be working.

    As for seeing a specialist, that often does take time unless it is ordered stat. Doctors aren't going to refuse emergency medical care while they wait for approval from the insurance company but they do need to wait until it is authorized. Most common reasons for a delay include the claim not being filed timely with the carrier and/or the authorization not being sent to the carrier in a timely manner. The latter being the cause 90% of the time. I've found most general urgent care facilities to be especially bad about this. In many cases the carrier's hands are tied if they either don't have the claim yet or they haven't received the request for authorization. An injured worker calling and asking for an appointment doesn't cut it for many reasons. It could also be that there are limited doctors who will take WC in your area and even more limited appointments available.

    Once you have been referred out, no Urgent Care facility will continue to treat you unless it is an emergency. That is true whether it is WC or not.

    For now I recommend asking your employer for work within your restrictions if you have not already done so. If they do not have work for you, let the carrier know and they can start benefits, though keep in mind there is usually a waiting period and the checks are usually on delay. I'd have been shocked if you had already been paid for an injury that happened 2/4.
    I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

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