What to Do When the Workers’ Comp Insurance Company Delays Benefits

Oct.27.2025
Work Comp

You’ve been injured at work, and now you need medical treatment and money to pay your bills. What should you do if the insurance company delays benefits?

Unfortunately, this is something that happens far too often. And it shouldn’t.

Workers’ compensation benefits are paid by your employer’s insurance company, which in the state of Georgia a business is required to have if they have three or more employees.

Georgia workers’ compensation insurance is designed so that, in the event of a workplace injury, workers can be compensated for medical treatment, rehabilitation, income benefits, and permanent disability.

According to the Georgia State Board of Workers’ Compensation, “Your employer’s insurance company has 21 days to investigate the injury and file a report with the State Board of Workers’ Compensation (SBWC).”

But it doesn’t always happen this quickly.

Let’s take a look at what you should do when the workers’ comp insurance company delays benefits.

How Insurance Companies Delay Benefits

Before we talk about what to do if the insurance company delays benefits, it’s important to have some idea why this may be happening in the first place.

Not enough hands – Insurance companies tend to be understaffed. Insurance adjusters have many cases they are handling at the same time, which slows down the process. It also opens the doors for mistakes to be made.
Mistakes in the paperwork – Workers’ compensation involves a tedious amount of paperwork, and one little error can delay the entire process. You may make an error, the doctor may make an error, or the insurance company may make an error.
Communication slows or halts – One of the more frustrating delay tactics is slowing down or halting communication. You may have a hard time reaching the insurance adjuster, or the doctor may not hear back in a timely manner.
Require second opinions – The insurance company does not want to spend money; they want to save money. So, if they can get a second opinion that saves them money, that’s what they are going to do. For example, let’s say the first doctor says you require surgery followed by physical therapy. The insurance company sees a high price tag. They’ll send you for a second opinion in hopes the second doctor will recommend cheaper medical treatment.
Looks into pre-existing conditions – Insurance companies may try to investigate your pre-existing conditions in order to find cause to deny workers’ compensation benefits.
Keeps requesting more information – There seems to be endless information required for workers’ compensation, and insurance companies use this to their advantage. They’ll keep asking for more information week after week instead of upfront to delay the benefits process.
Fails to authorize – Many medical treatments require pre-authorization or written authorization. When the insurance company fails to provide timely authorization, it can significantly delay medical treatment.
Doesn’t approve all prescriptions – Insurance companies may approve one prescription but not another. It may be a paperwork error or an actual delay tactic.

Watch Workers’ Comp Delay Tactics to Learn More

What to Do If the Insurance Company Delays Benefits

You don’t have to just sit back and wait for the insurance company to get their act together before you receive the workers’ compensation benefits you need and deserve.

There are things you can do to speed up the process if it’s going too slowly.

Write the Insurance Company and Your Employer

One of the first steps in dealing with insurance company delays is to simply address the issue.

Write to your employer and the insurance company and request the reason for the delay while also expressing your need for workers’ compensation benefits.

Make sure the letter includes the date you were injured and when you filed your workers’ compensation claim.

Your letter should also clearly indicate the workers’ compensation benefits you are missing out on, such as a weekly TTD (Temporary Total Disability) check, authorization to see a specialist doctor, or prescriptions.

This will start a paper trail, which may prove beneficial if you need to seek mediation.

Seek an Independent Medical Exam

One of the more common insurance company delay tactics is requiring a second opinion.

They do this in hopes that a different doctor will tell them what they want to hear – you don’t need workers’ compensation.

However, you have the right to seek a different opinion yourself within 120 days of receiving income benefits.

This is referred to as an Independent Medical Exam (IME).

Follow the Petition for Medical Treatment Process

If the insurance company’s delay is preventing you from receiving necessary medical treatment, such as medication, physical therapy, MRI, or surgery, you can request an expedited decision from a workers’ compensation judge.

In Georgia, this is known as the Petition for Medical Treatment (PMT) process.

This is a form that an attorney files requesting an expedited conference call with a workers’ compensation judge about medical issues.

Here’s the thing. The insurance company does not want to have a teleconference with the judge.

So, they tend to go ahead and approve whatever medical treatment is requested (or file a formal denial).

Generally, the insurance adjuster approves the request rather than having the call with the judge because it is something they should have already done and not delayed.

File a Claim

If you don’t receive benefits in a timely manner, you can file a claim, Form WC-14, with the State Board of Workers’ Compensation. This must be done within a year of the date of your workplace injury.

After filing a claim, there may be a hearing or mediation.

According to the Georgia State Board of Workers’ Compensation, “If you do not receive any benefits, you may request a hearing before the State Board of Workers’ Compensation. […] A hearing is like a trial in the courts of Georgia. Your claim will be decided by an Administrative Law Judge who listens to both sides of the claim and determines what benefits, if any, you should receive. The judge’s decision will be based on the law and the facts involved.”

Hire an Attorney

The first thing you should do when the insurance company delays benefits is to hire an attorney.

Attorneys are well aware of the lengths workers’ compensation insurance companies will go to in order to save themselves money – including delaying benefits until you give up.

Not only do they know that this happens, but attorneys are also aware of how they do it.

Your attorney will be able to find out why you are getting the runaround much quicker than you will.

Most importantly, experienced workers’ compensation attorneys know how to handle it when the insurance company delays benefits. Your attorney will know how to force the insurance company’s hands, so the process moves in a more timely manner.

If you have to pursue the petition process or seek mediation, you want an attorney in your corner.

And let’s just get real. The minute the insurance company hears you have an attorney, the less likely they will be to use their common delay tactics.

If you’ve been injured on the job, contact us today for a free, no-strings-attached consultation.

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