WC-PMT in Georgia Workers’ Compensation: Petition for Medical Treatment

Eligibility Criteria for Filing a WC-PMT

Not every treatment dispute qualifies for a WC-PMT. Georgia’s WC-PMT process is limited in scope and has specific eligibility requirements:

• Compensable Claim: The underlying workers’ compensation claim must be accepted as compensable (or determined compensable). You generally cannot use a WC-PMT if the claim (or the specific body part/injury) is still in dispute. The employer/insurer must already be responsible for the injury in question.

• Authorized Treating Provider: The medical treatment or test must have been recommended by an authorized treating physician (ATP) – typically a doctor from the employer’s posted panel or otherwise authorized in the claim. Both parties should agree on the treating doctor’s status. Recommendations from physicians who are not authorized treating providers generally do not qualify.

• Documentation and Prior Request: The treating physician’s recommendation must be in writing (e.g. office note, referral, or Form WC-205) and provided to the employer/insurer. The rule requires that the employer/insurer have the documentation of the recommended treatment or testing for at least 5 business days before a WC-PMT can be filed. In practice, this means the injured worker or doctor requested authorization and gave the insurer a chance to respond.

• Failure to Authorize: Despite having the recommendation for 5+ business days, the employer/insurer must have failed to timely authorize or schedule the recommended treatment. The WC-PMT is meant for situations where the insurer is silent or unreasonably delaying – not when they have already formally denied (controverted) the treatment or promptly approved it. If an insurer outright denies a treatment as not related to the work injury or not authorized, that usually triggers a different process (hearing) rather than a WC-PMT.

• Who Can File: The injured worker or their attorney may file the WC-PMT. It is not required to have an attorney – the Board rules explicitly allow an unrepresented injured worker to file the petition on their own. (However, as discussed later, having an attorney can be helpful during the process.)

In summary, a WC-PMT is available only when an accepted claim’s authorized doctor orders some treatment or test, the insurer has been asked and given at least five business days to approve it, and no approval (or scheduling) has been provided. Under those circumstances, the injured worker can invoke this special process to spur action.

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Step-by-Step Process for Submitting and Handling a WC-PMT

If you meet the eligibility criteria, the WC-PMT process unfolds in a rapid, structured way. Below is a step-by-step guide to filing a WC-PMT and what happens afterward:

1. Obtain the Doctor’s Recommendation: Ensure you have written documentation from the authorized treating physician describing the recommended treatment or test. This could be a referral slip, office note, or Board Form WC-205 completed by the doctor. The documentation should clearly identify the treatment (e.g. an MRI, physical therapy, surgery, etc.) and be from the authorized doctor for your work-related injury.

2. Submit the Request to Insurer and Wait 5 Business Days: Provide the doctor’s recommendation to the employer/insurer (usually the adjuster) and explicitly request authorization. It’s wise to do this in writing (for proof), and the doctor’s office may do it on your behalf as well. Under Board Rule 205, the insurer is supposed to respond to a doctor’s Form WC-205 request within 5 business days. Mark your calendar for 5 business days after the insurer receives the request. During this short window, the insurer may choose to authorize the treatment, deny it, or ignore the request.

3. Prepare the WC-PMT Petition: If 5 business days pass with no approval (and no formal denial) from the insurer, you can move forward with the WC-PMT. Complete the WC-PMT Petition for Medical Treatment form (available from the State Board’s website). On the form, you will fill Section B, “Petition to Show Cause Regarding Medical Treatment/Testing Recommended by Authorized Medical Provider.” You must describe the recommended treatment and list the treating provider who ordered it. Attach the supporting medical documentation (e.g. the doctor’s note or WC-205 form) to the petition.

4. File the WC-PMT with the Board and Serve Parties: File the completed WC-PMT form with the Georgia State Board of Workers’ Compensation (you can e-file, mail, or hand-deliver as per Board rules). At the same time, serve copies on all parties – typically the employer/insurer (and their attorney, if known) and also serve the authorized medical provider. The form includes a Certificate of Service (Section E) where you certify that you sent it to all parties on that date. Proper service is important to avoid any delays or claims of lack of notice.

5. Board Schedules a Telephonic Conference: Once received, the State Board will schedule a “show cause” telephonic conference with an Administrative Law Judge (ALJ) within 5 business days of your petition’s filing. This is a quick turnaround – the Board expedites these conferences given the medical urgency.

You (or your attorney) and the employer/insurer (or their attorney) will be notified of the date/time and dial-in number for the conference call. Note: Postponements are discouraged; any reschedule must also be within 5 business days of the original date.

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Employer/Insurer’s Options Before the Call

Upon receiving your WC-PMT petition, the employer/insurer essentially has three possible responses before the conference:

• Authorize the Treatment: They can agree to the request. The insurer would complete Section C (“Authorization”) of the WC-PMT form, stating that the recommended treatment is authorized, and file that with the Board (and notify the doctor). If they do so, the scheduled conference is canceled as the issue is resolved. (The insurer’s representative must have authority to bind the company when signing this section.)

• Controvert (Deny) the Treatment: Alternatively, they can formally controvert (deny) the requested treatment. To do this, the insurer completes Section D (“Controvert in Lieu of Telephonic Conference”) on the form, stating the specific reason for denying the treatment. Filing this also cancels the conference. Importantly, the Board rules state that if the insurer files the Section D controvert, it constitutes official notice of denial for that treatment – no separate Form WC-3 “Notice to Controvert” is required for the medical issue.

• Do Nothing and Attend the Call: The insurer may decide not to authorize or deny immediately, and instead contest the matter at the conference. In that case, the telephonic show-cause hearing will proceed as scheduled. (If the insurer simply ignores the petition entirely, the conference will still proceed without their input, and the judge can still issue a ruling.)

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Resolution

If the matter wasn’t resolved beforehand, a teleconference is held with an ALJ (essentially a brief informal hearing by phone). During this call – usually held within roughly two weeks of the initial treatment request – the employer/insurer must “show cause” why the recommended care has not been authorized. In practice, each side can state their position. The judge may ask questions to understand if the insurer has a valid reason for delay. The injured worker (and/or their attorney) can argue why the treatment is necessary and related to the injury. Failure of either party to participate in the call does not prevent the judge from proceeding and ruling – so even if the insurer doesn’t show up, the judge can act.

Judge’s Interlocutory Order: After hearing from both sides (or hearing only the petitioning worker if the other side doesn’t attend), the Administrative Law Judge will typically issue an Interlocutory Order shortly after the conference (sometimes the same day or within a few days). This order will either authorize (approve) the requested treatment or deny it. If the judge finds the treatment is reasonable, necessary, and related to the injury, the order will direct the employer/insurer to provide written authorization to the medical provider for that care. If the judge is not convinced (or if the insurer showed a valid reason), the order may deny the request. Either way, this order is interlocutory, meaning it is a preliminary decision – it is not a final adjudication of the issue beyond the immediate question of authorization.

After the Order – Appeal or Compliance: Once the ALJ issues the order, the parties have 20 days to object by requesting a formal hearing. Either party can file a Form WC-14 within 20 days to essentially appeal the interlocutory order and have the issue heard in a full evidentiary hearing. If no one requests a hearing within 20 days, the interlocutory order becomes final and binding. The Board treats the absence of a hearing request as consent to the order. For example, if the judge ordered the treatment and the insurer does not appeal in time, the insurer is deemed to have consented and must pay for the treatment per the fee schedule. Conversely, if the judge denied the treatment and the worker doesn’t appeal, that effectively ends the dispute (the denial stands).

Formal Hearing if Needed: If a hearing is requested, the issue will proceed just like a regular contested workers’ comp hearing, with discovery, evidence, and eventually a trial before an ALJ (likely a different ALJ than the one who handled the conference). The interlocutory order is stayed (put on hold) once a hearing is requested, so an order directing treatment will not be enforced while the hearing is pending. At the hearing, each side can present witnesses (including doctors’ testimony) and evidence on whether the treatment is reasonable, necessary, and related to the work injury. The judge at the hearing will issue a final award deciding the issue. This final decision can then be appealed through the normal workers’ comp appellate process if desired.

If the final result (either by no appeal of the PMT order, or after a full hearing) is that the treatment is authorized, the injured worker has the right to get that treatment and the insurer must cover it. If the final result denies the treatment, the worker may need to seek alternative medical opinions or treatments or consider other legal options if new evidence arises.

In many cases, the whole WC-PMT process from doctor’s recommendation to a telephonic judge’s order can take place in a matter of 1–2 weeks, which is a vast improvement over the months-long wait for a standard hearing. For example, a petition might be filed on a Monday, a conference call held by the following week, and an order that same day – as opposed to waiting several months on a crowded hearing docket. This rapid response is precisely why the WC-PMT was introduced.