An injured worker is entitled to medical treatment for his on-the-job injury, but he must obtain his care from an employer-authorized physician. Under O.C.G.A 34-9-201, employers are required to have a valid list of approved doctors (referred to as a “panel of physicians”) posted in a prominent place from which injured employees must select a work-injury doctor. If the panel isn’t posted or isn’t valid, then the worker may select any workers’ compensation doctor in Atlanta of his choosing as his authorized care provider.
The Validity of the Panel of Physicians
Georgia law provides very specific elements that a panel must have in order to be valid, some of which are listed below.
- The panel must be posted in a conspicuous location at work, such as in the break room, cafeteria, lobby, or clock-in station;
- There must be a minimum of six doctors on the list;
- The panel must not contain more than two industrial clinics; and
- At least one of the physicians must be a minority.
Additionally, the law states that employers “must take all reasonable measures to ensure the employee understands the function of the panel and the employee’s right to select a physician therefrom in case of injury.” If you need assistance contacting one of the physicians, the employer is obligated to help. You are entitled to change your physician to another on the list once without obtaining permission from the State Board of Workers’ Compensation.
The Importance of Selecting Your Authorized Physician
If you suffered a work injury and your employer doesn’t have a 100 percent valid panel of physicians posted, you will be entitled to select a doctor of your choosing.
Why is this so important? Because the doctor you select as your authorized work-injury physician is the one in control of your care, as well as your work status. Your doctor dictates what happens with your medical care. It’s the role of the authorized physician to determine when you are unable to work, when you are fit to return to light duty, and when you can return to full duty. Your authorized doctor is also the one who will have the authority to refer you to specialists approved under workers’ compensation benefits.
Employers and their insurers tend to select conservative doctors for their panel; that is, doctors who are more favorable to the company. Employer-approved physicians might be more conservative with your care, for example, opting for more conservative treatments in order to reduce the insurer’s costs. They may also be quicker to approve you for light duty or full duty than a truly independent doctor might be. In other words, doctors on the panel are often slow to treat and fast to release you to work.
For instance, let’s say you suffer a meniscus tear on the job. A conservative employer-chosen physician might put you right back on light duty with few restrictions. A doctor who’s more claimant-friendly, on the other hand, will be sensitive to the potential long-term harm that prematurely returning to work can have on your knee. He or she might put you on no work status until you can safely return to light duty, and then gradually to full duty.
Choose from a Panel of Physicians
Your employer is required to provide you with a panel of at least six qualified doctors or a Managed Care Organization (MCO) to choose a physician. In general, you are required to see one of the doctors provided under these terms. Very often, your employer’s insurance company provides you with a list of providers who are part of their network. This works in a manner similar to typical health care from your regular provider.
Once you choose a doctor, he or she is known as your authorized treating physician or ATP. You may receive treatment from an ATP for up to 400 weeks for injuries that are not deemed catastrophic. The doctors in the panel must be located within 50 miles of your job site. The costs associated with medical care are covered through workers’ compensation and you should not have to pay for any of these expenses out-of-pocket.
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Can I Visit My Own Physician?
You may be tempted to utilize your own doctor after you suffer an on-the-job injury. After all, your doctor already knows you and your medical history and you can easily get an appointment. However, be aware that you must follow the procedures that are in place regarding workers’ compensation injuries. If you fail to follow the rules and visit your own doctor, your workers’ compensation claim could easily be denied. When you utilize your own doctor, the insurance company does not need to approve benefits. If you need a specialist, your ATP will provide you with a referral. Discuss the matter with an Atlanta workers’ compensation attorney for guidance throughout the process.
Changing Your Authorized Treating Physician
The law recognizes that you may not always be completely happy with your ATP. For this reason, you are allowed to change your physician once. You can make a change of physician without prior approval one time during your claim. You must choose another doctor from the panel or network of physicians. Under some circumstances, you may be able to make subsequent changes to your physician. You must receive prior approval for such a request. In some instances, you may be allowed to get an opinion from your own doctor. Such is the case when you need to obtain an independent medical examination (IME).
Choosing a Doctor for Your Care
In the event that you are injured on the job and need to take advantage of workers’ compensation, you will most likely not be able to go to your normal personal physician for your care, unless – coincidentally – your personal doctor happens to be one of the approved workers’ compensation doctors chosen by your employer, which is an unlikely scenario. Your employer is required to post a list of approved workers’ compensation doctors somewhere that is easily accessible to workers. You must choose one of the doctors from this list to receive your work-related injury treatment from. The list should be clearly labeled and should give the name, specialty and contact information for the employer-approved workers’ compensation doctors.
Going to a doctor that is not on the employer-approved list is considered unauthorized treatment, and workers’ compensation will not cover any unauthorized treatments received by injured workers from unauthorized doctors. Any treatment sought from an unauthorized doctor must be paid for out of pocket by the injured worker as most health insurance policies do not cover treatment for work-related injuries.
If you select a doctor, and attend an appointment with your chosen employer-approved doctor, but you are dissatisfied with the care you received, you are permitted to choose a different doctor from the employer approved list. You may change doctors one time. If you are still dissatisfied, you must consult with your employer or your employer’s workers’ compensation coordinator or administrator.
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Emergency Situations That Require Immediate Care
Some workplace accidents result in serious or life-threatening injuries that require immediate medical treatment. In truly emergency situations, an injured worker is not required to go to one of the employer-approved doctors. Instead, workers who need emergency medical care are permitted to go to the nearest emergency treatment facility and can still seek workers’ compensation to cover the costs of the emergency care, even though the treating emergency doctor is not an approved doctor. This includes coverage for emergency treatments such as scans, diagnostics and emergency surgery procedures. Once the emergency has passed, and the injured worker has stabilized enough to no longer require the emergency care, the worker is then required to seek medical care from an employer-approved doctor.
When You Need Additional Tests and Procedures
Upon working with an employer-approved workers’ compensation doctor, the doctor may require the injured worker to seek special tests, scans or procedures that the doctor him or herself cannot perform. These tests, scans or procedures must be referred out to another doctor of facility. In such a scenario, your doctor will coordinate with your employer concerning getting you the tests, scans or procedures you need to recover from your work injuries. The arrangements will be made for you, and your employer’s workers’ compensation coordinator or administrator should contact you letting you know when and where your test, scans or procedure will be conducted. This is true if you need a MRI scan, CT scans, specific surgical procedure, physical therapy, etc.
What Else Will Workers’ Compensation Cover?
Workers compensation will cover the cost of emergency treatment, treatment from authorized workers’ compensation doctors, authorized scans, tests and medical procedures, physical therapy, prescription medications, and prescribed therapies. Generally speaking, your employer’s workers’ compensation coordinator will be involved in making sure you get the treatment you need and that workers’ compensation takes care of the bills. However, in some situations you may be required to pay up front, and seek reimbursement from your employer’s workers’ compensation program.
Specifically, you may be required to pay for prescriptions and for your mileage, food and lodging costs while receiving care, but these costs can be reimbursed to you through workers’ compensation. Waiting more than a year to seek reimbursement disqualifies your expense from being reimbursed.
Injured workers who would like to be reimbursed for these costs should contact their employer’s workers’ compensation coordinator or administrator and work out how to obtain reimbursements. Reimbursement documents need to be filed within a year of generating the expense. Once you have figured out what your employer’s reimbursement procedure is, you can file for your reimbursement and you should receive reimbursement within 15 days for approved expenses.
Does your employer have a valid panel posted?
Our attorneys at Bader Scott Injury Lawyers, work with injured workers on a daily basis and help them through all types of workers’ compensation issues. When it’s time for them to select their work injury doctor, the first thing we must establish is whether or not their employer had a valid panel of physicians posted in a prominent place at work on the date of injury.
We usually ask the claimant to look around the workplace for an official notice and take photos to share with us. It might also help to take a picture with some context – for example with a co-worker standing near it – to prove that it is posted at the worker’s place of employment. This way, we can thoroughly review the list and determine its validity. If the panel lacks the basic elements required, then the worker will be free to choose his own independent physician.
For help with your work injury case or for questions about your rights to care under workers’ compensation, call our firm for a free consultation. Contact us today at (404) 888-8888.