What types of medical treatment are (and are not) covered under workers’ comp in Georgia?
A question that clients commonly ask us is:
“What type of medical treatment can I receive under workers’ compensation?”
This is an excellent question and one that has many different answers. The answer can vary based upon 2 main factors:
- Is medical treatment being provided for by the workers’ compensation insurance company?, or
- Has workers’ comp been denied?
Let’s start with the second factor since the answer is more straightforward.
When workers’ comp is denied
When a workers’ compensation case has been denied, for whatever reason, the employer will not pay and therefore no medical treatment will be covered under Georgia workers’ compensation insurance.
A denial means that the insurance company (or an attorney on their behalf) has filed an official notice to controvert with the State Board of Workers’ Compensation. This can be completed on either a WC-1 (First Report of Injury form) or on a WC-3 (Notice to Controvert form).
It’s important to understand that a denial of your workers’ compensation claim doesn’t mean that you (the injured worker) can’t receive treatment. It merely means that the insurance carrier is not voluntarily agreeing to pay for said medical treatment.
In this instance, any and all treatment options are available to the injured worker — from emergency room and orthopedic care, to chiropractic and homeopathic care. Unfortunately, the injured worker will be personally liable for all of the medical bills unless their health insurance pays for them, or unless they have another type of insurance that would pay the bills.
It’s very important to inform any and all doctors that you may treat with that you were injured at work. The medical records can be used at trial to help establish both that you were injured at work and that you received medical treatment for that injury.
When workers’ comp pays for medical treatment
Remember, there are 3 main types of benefits an injured worker can receive once they have been hurt on the job:
- Medical treatment. Medical expenses covered by Georgia’s workers’ compensation include diagnostic tests, emergency room visits, alternative treatments, prescriptions, ongoing treatment and care, and travel expenses to doctor’s appointments.
- Indemnity (lost wage) benefits. An individual is entitled to indemnity benefits if they are either taken out of work by the authorized treating physician for 7 consecutive days or they are placed on work restrictions by the authorized treating physician and the employer cannot meet those restrictions or offers less work and less pay than before the injury.
- Permanent partial disability. The final benefit is the permanent partial impairment rating, which is determined by the authorized treating physician.
When a workers’ compensation claim is denied, none of these benefits are available.
However, just because an insurance company or the employer denies your case at the beginning, doesn’t mean that it will always be denied. The insurance company can decide to “pick up” the claim at a later date after their investigation is complete, or they could lose at trial and the judge might determine that the accident did indeed occur on the job and the resulting disability is work-related.
This is one of the reasons why it’s so important to ensure that all doctors that treat an injured worker document both the cause and nature of the injury, as well as the work status of the injured worker. It’s harder to go back and retrace steps with a provider’s office than it is to get that information at the appointment. This holds true for any medical professional who sees an injured worker in a denied case, including chiropractors and physical therapists.
Reasons why an insurance company will pay for medical treatment
There are 2 main ways that an insurance company will pay for medical treatment once it is initially denied.
First, the insurance company can agree to start paying on the claim for whatever reason. There may be penalties associated with this so it rarely happens without an attorney being involved.
O.C.G.A. 34-9-200(a)(1) states that:
(T)he employer shall furnish the employee entitled to benefits under this chapter such medical, surgical, and hospital care and other treatment, items, and services which are prescribed by a licensed physician, including medical and surgical supplies, artificial members, and prosthetic devices and aids damaged or destroyed in a compensable accident, which in the judgment of the State Board of Workers’ Compensation shall be reasonably required and appear likely to effect a cure, give relief, or restore the employee to suitable employment.
When the insurance company decides to pick up a case after initially denying it, the insurer doesn’t get to choose the doctor (pursuant to O.C.G.A. 34-9-201). Therefore, the standard of reimbursement for the treatment that has already taken place falls under the statute cited above.
To put it simply:
- Was the treatment likely to effect a cure and give relief to the injured worker?
- Did the treatment help the injured worker in their quest to return back to work?
If the answer is yes, then the insurance carrier may be required to pay for the treatment under the Georgia Fee Schedule (O.C.G.A. 34-9-205).
The second way that an insurance company can be required to pay for a medical treatment is through an order from the State Board of Workers’ Compensation. This order can be obtained either after a hearing before an administrative law judge or after a motion has been filed. The judge will issue an order requiring treatment to be approved and/or paid for by the insurance company. This treatment can include orthopedic, chiropractic or other types of care. It’s in the judge’s discretion to make a ruling on what care is approved and paid for.
Does workers’ comp cover medical marijuana?
Finally, the issue of medical marijuana is often raised by clients. Currently, medical marijuana is only allowed in the form of cannabis oil and under extremely limited circumstances in Georgia. We have yet to see any circumstance where a physician prescribes medical marijuana in Georgia for a workers’ compensation injury.
The question does arise, however, if an individual has moved outside of Georgia to a state where marijuana is legal. It’s important to note that marijuana is still illegal on the federal level. If an authorized treating physician prescribes marijuana in that state for say, PTSD, the question arises if a Georgia workers’ compensation insurance carrier would have to pay for that. This is a matter of first impression in Georgia and the courts have not yet decided this.
Need legal advice?
Contact an experienced Georgia work injury lawyer
As you can see, almost any medical care CAN be paid for under workers’ compensation. It is just a matter of getting the insurance company to pay for it. This is why it’s important to hire an experienced attorney, such as those at Gerber & Holder, to assist you in getting medical treatment under the Georgia workers’ compensation statute.
If you have any questions about medical treatment or anything else related to workers’ compensation, don’t hesitate to contact the Atlanta workers’ compensation attorneys at Gerber & Holder Law.