One of the most common reasons for medical treatment delays is a process called prior authorization. In workers’ compensation cases, this approval process can influence everything from your first physical therapy session to long-term surgery plans. When treatment is delayed or denied, it doesn't just slow healing—it puts your legal rights at risk.
At Forbes Law Firm, we’ve stood beside injured workers across Hampton Roads, Virginia, for decades. Over the years, we’ve seen how medical treatment delays can jeopardize recovery and add financial strain.
Our experience in workers’ compensation allows us to handle these matters with precision and care. We know how to push back when insurers try to sidestep their responsibilities, and we help our clients understand each step in the process.
Prior authorization is supposed to serve as a medical checkpoint, but too often it becomes a tool to reduce care or avoid cost. That’s why knowing how it works and how we can respond is so important.
In simple terms, prior authorization is a request for the insurance carrier to approve a specific treatment before it happens. In most workers’ compensation cases, medical care isn’t immediately covered unless it's been cleared through this step.
Insurers usually require prior authorization for:
Specialist referrals: Such as neurologists, orthopedists, or pain management doctors
Diagnostic imaging: Including MRIs, CT scans, or X-rays
Physical therapy: Especially if it extends beyond a few initial sessions
Surgical procedures: From minor outpatient procedures to major operations
Prescription medication: Particularly when narcotics or brand-name drugs are involved
Without prior approval, medical providers may refuse to treat or may expect the injured worker to pay out-of-pocket. For this reason, experienced workers’ compensation attorneys often coordinate early with medical offices, submit necessary documentation, and appeal wrongful denials to avoid these costly and harmful delays.
From the insurer’s point of view, prior authorization allows them to control costs and confirm that treatment is medically necessary. But in workers’ compensation cases, this approach often works against the very people the system is supposed to protect.
Insurers argue they’re trying to:
Verify necessity: To avoid unnecessary procedures or duplicated services
Confirm coverage: Making sure the treatment is tied to the work injury
Limit fraud: By preventing unauthorized or inflated charges
Though these reasons might sound reasonable in theory, the real-life effect on injured workers can be harsh. Legitimate medical care may be delayed, leaving injured individuals and their legal counsel to fight for basic approvals that should be issued without resistance.
When prior authorization is excessively delayed or denied without cause, it can seriously disrupt the recovery process and jeopardize long-term health. Many workers have been informed by their physicians that a treatment is medically necessary, only to have it held up by an insurer's bureaucratic process.
Delays in care can result in:
Worsening injuries: Especially with soft tissue damage, spinal issues, or nerve injuries
Increased pain and stress: Which can affect mental health and sleep
Reduced work capacity: Making it harder to return to the job or perform modified duties
Extended disability periods: Which can lower income and affect benefits eligibility
These setbacks don’t just impact health—they can also weaken the overall workers’ compensation case. Denied or postponed treatment makes it more difficult to demonstrate the injury’s long-term consequences, which is why experienced legal professionals stay on top of every authorization request.
If your treatment is denied, it doesn’t mean the process is over. Under Virginia workers’ compensation law, there are clear steps we can take to challenge those decisions.
Those steps may include:
Requesting written denial reasons to understand the insurer's justification
Collecting medical documentation from treating physicians supporting the need for care
Filing motions or petitions with the Virginia Workers’ Compensation Commission
Exploring alternate providers who are more responsive to legal and medical documentation
Legal professionals who handle these cases regularly often see denials overturned after thorough documentation and formal appeals. Knowledge of how to use the system’s procedural tools is critical to holding insurers accountable and securing timely medical care.
Your treating physician plays a major role in the prior authorization process. Their opinions often carry more weight than any independent medical reviewer or insurer-appointed doctor. That’s why choosing the right authorized treating physician is so important.
A strong legal advocate may assist injured workers in:
Choosing a physician who understands the workers’ compensation process
Coordinating paperwork such as treatment plans, records, and summaries
Requesting timely updates so that any new treatment recommendations are documented quickly
When treating physicians are engaged and understand how to work within the system, both care and case outcomes typically improve.
In Virginia, workers’ compensation cases must follow strict timelines for reporting injuries, filing claims, and appealing decisions. Prior authorization delays can make it harder to meet those timelines, especially if treatment is necessary to prove disability.
Delays can interfere with:
Returning to work: Which may reduce wage loss benefits or expose clients to termination
Reaching maximum medical improvement (MMI): A key milestone in permanent disability ratings
Securing settlement offers: Since unresolved treatment makes it difficult to assess long-term needs
Attorneys handling these cases often monitor deadlines closely and may request expedited hearings when prior authorization puts a case at risk.
Getting legal help early—before prior authorization becomes an obstacle—can make a major difference. Legal advocates familiar with insurer behavior can anticipate delays and work to speed up approvals between recommendation and authorization.
A proactive legal strategy typically includes:
Reviewing initial medical documentation to confirm care aligns with the injury
Communicating with medical providers to coordinate documentation
Tracking each authorization step, including insurer responses and physician recommendations
Filing motions or appeals when approvals are unfairly denied or delayed
Documenting every event to preserve evidence and build a stronger case
Workers’ compensation isn’t just about financial benefits—it’s also about making sure injured workers get the care needed to recover and move forward.
While we handle the legal pressure, there are things you can do to protect your health and your claim if you’re stuck waiting on authorization.
Helpful actions may include:
Keeping a symptom journal: Track pain levels, mobility, and limitations each day
Attending all scheduled appointments: Even if the full treatment plan is still pending
Communicating with your doctor: So they know how your injury is progressing
Following temporary restrictions: Including light-duty work or activity limits
Saving all paperwork: Including denial letters, emails, and billing notices
These efforts not only support continued medical treatment—they also provide valuable evidence that attorneys can use to advocate more effectively before insurers or the Commission.
If you're dealing with prior authorization delays in your workers’ compensation case, you don’t have to face the system alone. At Forbes Law Firm, we help injured workers throughout Hampton Roads, Virginia, including Hampton, Newport News, Poquoson County, York County, and Williamsburg, get the care they need and the benefits they’re entitled to. Reach out to an experienced workers’ compensation lawyer today and let us take the weight off your shoulders.
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