What types of medical treatment are covered under Georgia workers’ compensation laws?
When a person is hurt on the job in Georgia, they are entitled to medical treatment for their injured body part. This medical treatment is to be paid by the workers’ compensation insurance company and the injured worker doesn’t have to pay anything out-of-pocket for this treatment.
Of course, nothing in life is ever truly free, and the same is true in workers’ compensation.
If the insurance company follows the regulations set out in Georgia law (O.C.G.A. 34-9-200 and 34-9-201), then the injured worker is limited as to the doctor he or she can choose. In this article, we’ll discuss who the injured worker can treat with and what type of treatment they can receive.
3 ways an insurance company handles a work injury claim
In a practical sense, there are 3 positions an insurance company can take with regard to an injured worker—and all of them affect your medical treatment. The insurance company can:
1. Accept the injury as an accepted compensable claim. This means that the insurance company has acknowledged that the individual was injured on the job, so they are eligible for medical treatment and indemnity benefits (lost wages).
2. Accept the case as medical only. This is an amorphous situation in which the insurance company is paying for medical treatment, but has not paid indemnity benefits because either they are not due, or statutorily they aren’t required to and they have chosen not to commence them.
3. Deny the case. The insurance company has put forth the legal position that the individual was not injured on the job and therefore is paying for neither medical treatment nor indemnity benefits.
Requirements for a panel of physicians
In accepted medical-only claims, the injured worker is initially limited to treatment with a doctor on the panel of physicians. The panel of physicians is a list of doctors that the employer should have prominently posted at their office or job site. Georgia law (O.C.G.A. 34-9-201) lists the requirements of the panel.
At a minimum, it must contain:
- A list of 6 physicians
- At least 1 doctor shall be an orthopedic specialist
- No more than 2 industrial clinics shall be included on the panel
- There must be at least 1 minority physician
What types of doctors can an injured worker choose
If the employer fails to have a panel, or if a panel fails to comply with the requirements listed above and the employer didn’t get a special waiver in advance, then the injured worker can choose their own doctor.
They can pick a chiropractor, physical therapist, family physician, or whichever medical provider they want so long as that facility accepts payment under the Georgia fee schedule for workers’ compensation.
The choice of doctor doesn’t end there for the injured worker. If the injured worker is not satisfied with the care that their initially selected doctor has provided, they are allowed a one-time switch in authorized treating physicians to another doctor of their choosing.
An example of this could occur in a work-related motor vehicle accident. The injured worker could seek treatment with a chiropractor after their initial injury. Subsequently, when the injury turns out to be more than the chiropractor can handle, the injured worker can make a one-time switch to an orthopedic specialist. However, if the chiropractor recognizes that the injured worker needs an orthopedic specialist and refers them to one, that referral has to be honored by the insurance company and the injured worker will not have to use their one-time change in authorized treating physicians.
Exceptions to a worker’s right to choose their doctor
It is important to note that there is a provision which can invalidate the injured worker’s right to choose any doctor they want.
O.C.G.A. 34-9-201(e) states:
Upon the request of an employee or an employer, or upon its own motion, the board may order a change of physician or treatment as provided under Code Section 34-9-200.
This statute means that even if the employer fails to either have a panel or has a panel that is invalid, they can still petition the court to appoint an authorized treating physician. It should be mentioned that the employee has the same rights as the employer and can also file a motion with the court.
If your workers’ comp claim is denied
If your claim is denied, the insurance carrier cannot force the injured worker to treat with a certain doctor. In fact, the injured worker can treat with whomever they want to treat with if their claim is denied.
If the injured worker goes to a hearing and the case is deemed compensable, the injured worker can request that the judge make the doctor they were treating with the authorized treating physician and require the insurance carrier to pay their bills. Additionally, a judge can determine that all of the treatment in the past was necessitated by the on-the-job injury and make the insurance carrier pay for that treatment as well.
If you are receiving wage loss benefits
When an individual is receiving indemnity benefits, or has received them within the past 120 days, they are entitled to an independent medical examination (IME) with a doctor of their choosing that the insurance carrier has to pay for.
There are limits on the amount of payment and those are codified in Georgia law (O.C.G.A. 34-9-202(e) and Board Rule 202 (b)). These limits state that the insurance carrier shall not have to pre-pay more than $1,200 for an appointment, nor do they have to pay for diagnostic procedures that haven’t been previously performed.
The injured worker can choose any doctor for their IME. However, if the goal is providing evidence of an injury for an upcoming hearing, or with an eye toward changing doctors, the reputation and specialty of that doctor should be considered. By reputation we mean both in the medical community and with the judges at the State Board of Workers’ Compensation.
Contact an experienced Georgia workers’ compensation attorney
There are many ways to choose doctors, and many choices of doctors in the workers’ compensation system in Georgia. If you have any questions about how to choose a doctor, or which doctor to choose, don’t hesitate to contact the Athens work injury attorneys at Gerber & Holder Workers’ Compensation Attorneys.