When a Georgia workers’ compensation insurer delays approval for medical care, an injured worker may be able to use a Petition for Medical Treatment, often called a PMT. The process is designed to move quickly, but it does not always lead to fast treatment. In practice, it is expedited mainly when the insurer agrees to authorize the care.
Key takeaways
- A PMT may be filed after the insurer has had five business days to respond to a medical request.
- The judge may schedule a conference call soon after the petition is filed.
- The insurer can authorize the treatment, deny it, or dispute an order approving it.
- If the dispute continues, the issue may take months to resolve through a formal hearing.
- A PMT is not a guarantee that an MRI, surgery, or other treatment will happen quickly.
What is a Petition for Medical Treatment?
Suppose your authorized treating doctor orders an MRI. The medical request needs to be provided to the workers’ compensation attorney or insurance adjuster handling the claim.
The insurer generally gets five business days to respond. If that time passes without authorization, the injured worker may file a Petition for Medical Treatment, or PMT, with the State Board of Workers’ Compensation.
The PMT tells the Board that medical treatment was requested but has not been approved. It asks a workers’ compensation judge to address the delay.
This process can apply to different types of medical care, depending on the facts of the claim. Examples may include:
- Diagnostic testing, such as an MRI
- Specialist appointments
- Physical therapy
- Injections
- Surgery
- Other treatment recommended for a covered workplace injury
Whether the treatment should be covered depends on issues such as medical necessity, the connection to the work injury, and the terms of the workers’ compensation claim.
What happens after a PMT is filed?
After the petition is filed, the issue may be placed on a judge’s calendar for a conference call. That call could be scheduled only a few days later, which is why the PMT process is often described as expedited.
Before the conference call, the insurer may take one of several actions:
- File a PMT authorization. This means the requested treatment is approved.
- File a PMT controvert. This means the insurer is denying or disputing the treatment.
- Explain the delay during the conference call. The judge may hear from both sides and decide what should happen next.
Sometimes the authorization arrives at the last minute, even shortly before the scheduled call. That can be frustrating because the issue could have been resolved earlier, but approval at least allows the treatment to move forward.
What if the insurer denies the treatment?
A PMT controvert does not necessarily end the dispute. It means the insurer is contesting the requested care. The injured worker may then need to address the denial before a judge.
In some cases, the judge may order the insurer to authorize the treatment during the conference process. That sounds like a final solution, but it may not be the end of the matter.
The insurer can still file a request for a formal hearing to dispute the judge’s order. When that happens, the issue may return to the regular hearing process. It can take months to reach a final decision.
That is the main limitation of Georgia’s expedited medical treatment process. It may create an early opportunity to resolve the problem, but a contested issue can still move slowly.
Why the process is only “kind of” expedited
The PMT procedure works quickly when the insurer decides to authorize treatment. If approval is filed before the conference call, the injured worker may get what was requested without a long hearing.
But if the insurer continues to dispute the treatment, the timeline changes. A conference call is not always the same as a final resolution, and an order approving care may still be challenged.
In simple terms:
| Situation | Possible result |
|---|---|
| Insurer authorizes treatment | Care may move forward quickly |
| Insurer does not respond | A PMT may be filed |
| Insurer files a controvert | The treatment remains disputed |
| Judge orders treatment | The insurer may still request a hearing |
| Formal hearing is needed | Resolution may take months |
Practical steps for an injured Georgia worker
If medical treatment is delayed, keep copies of the doctor’s order and any messages or letters about the request. It is also important to know when the request was sent and when the five-business-day period ends.
Do not assume that a doctor’s recommendation automatically means the treatment has been approved. Until authorization is confirmed, billing and scheduling issues may remain.
A Georgia workers’ compensation attorney can help determine whether a PMT is appropriate, whether the treatment is related to the workplace injury, and what options exist if the insurer files a controvert. Gearhart Law Group focuses on explaining Georgia workers’ compensation benefits and the limits that may apply to medical care, wage benefits, and disability claims.
The key point is straightforward: Georgia has an expedited process for delayed medical treatment, but it is truly fast only when the insurer agrees to authorize the care.
