Dealing with Doctors and a Workers Comp Claim Denial

Workers compensation, filing a claim, and dealing with doctors is a lot for any person to handle. But when you add in that you are trying to get the medical attention you need or recover from an accident, these tasks seem impossible. Atlanta workers compensation attorneys are there to aid you through every step of the process. That includes workers comp claim denial and knowing what your rights are when dealing with doctors.

Your Rights for Medical Treatment

Unless you work in particular fields such as the railroad or maritime industries, it’s likely that you qualify to submit a claim for workers comp. Denied claims don’t mean that you don’t qualify for coverage either, many issues and mistakes lead to denied claims. You may still have the right to proper medical help, but you will need the aid of a workers comp attorney, or you may fall through the many holes in the system.

In short, you have the right to medical care after any work-related injury, accident or illness. In some cases, you may have the right to get treatment if a preexisting condition worsens because of your work.

Your employer must have a complete posting explaining your rights, and they must provide a list of physicians that you can choose from for treatment. If your employer failed to give you this list or the info for your coverage, then you may choose a doctor.  Some companies will use these situations as a means for a claim denial showing that you did not go to an approved doctor. This process can become a legal mess, and it’s best to involve a lawyer.

Denied Treatment and Denied Claims

There are many times when a doctor from the selected panel will refuse to treat or even see someone with a workplace injury. This is a bad tactic to prolong the time between filing a claim and getting help which may lead to a denied claim.

If a doctor denied you treatment or examination, seek out a doctor of your own choice. In GA the law allows an employee injured because of work to go through treatment with their doctor if the worker’s comp doctors refused treatment.

But most injured employees don’t make it that far. Don’t get caught in the cycle of denial where you can’t get medical help, which leads to a claim denial, and eventually, you suffer for much longer all without compensation. If you need medical aid and are losing money on medical bills or lost wages get a workers comp attorney.

Did You Get a Second Opinion?

If you’re not happy with the medical care from the first doctor, then you may be able to change your doctor. In GA you can only do this once so you will want to talk to a Georgia workers comp lawyer before choosing your next doctor. Denied claims may have time restrictions on seeking a second opinion, and an attorney should aid you through these time restraints.

File an Appeal with an Atlanta Workers Compensation Lawyer

A denied claim will likely fall hand in hand with the doctor handling your case. A denied claim may come from a wide range of justifications that insurance companies and employers use.

They may fall back on policy or procedure that they don’t use in day to day practices, or they may use the doctor to refuse treatment until the time frame of your claim makes it null. In these cases, you need to file an appeal. There is also the chance that there was an honest mistake on one of your claim forms.

Speak with a workers comp lawyer before filing an appeal because the paperwork and claim requirements are confusing and it is easy to make mistakes. A lawyer can help you communicate with the insurance company in seeking treatment while dealing with a denied claim.

A lawyer should prepare you for the appeals process which can take a long time but should also help you avoid the need to take legal action. An appeal starts with you submitting all the information you have on the injury along with the records of medical treatment or care. Then your company has the chance to present their side, and a state official will mediate the session to reach a resolution.