How Medical Treatment Is Provided in Georgia Workers' Comp Claims

How Medical Treatment Is Provided in Georgia Workers' Comp Claims

Posted By Douglas F. Kaleita, P.C. || 23-Jun-2015

In Georgia workers' compensation claims, the injured worker is entitled to medical treatment at the employer and insurance company's expense for any work injuries. While there are a few methods through which such treatment can be provided, the most common method in use today is the "panel of physicians."

The panel of physicians is supposed to be posted in a noticeable location on the employer's premises. Furthermore, the employer is supposed to explain to the injured worker how the panel works and their right to choose a physician from the panel. Georgia law entitles the injured employee to select an initial treating doctor from the panel of physicians. The panel must have at least six different providers, with no more than two industrial clinics and at least one orthopedic surgeon on the panel.

What to Look Out for in the Panel Process

The injured worker should always ask right away to see the posted panel of physicians, so that he or she can make a choice as to which doctor to see. However, most employers fail to meet their responsibility to inform their injured employees about the panel process, only directing them on where to show up without further explanation. This often means the employer is the one who selects the treating physician. How do they get away with this? The rules say that the injured employee can either pick a doctor from the panel after being injured or allow the employer to suggest a doctor. If the employee agrees with that choice, the suggested doctor becomes the Authorized Treating Physician. Most of the time, this is exactly what happens.The employee does have the right to change doctors once within the panel of doctors if they do not like the first doctor.

If there is no panel posted, or if the posted panel is not valid because it does not comply with the above requirements, the injured employee is free to pick their own doctor. The employee can then pick whomever they want, including a chiropractor. In such cases, the employee is still free to change doctors once to another doctor of his or her own choice.

What happens after a physician is selected?

Once an Authorized Treating Physician is chosen, that doctor is free to prescribe whatever treatment is necessary for the employee's work injury. The Authorized Treating Physician, called the ATP, is also free to refer the injured worker to other doctors or specialists for treatment, which is supposed to be paid for by the employer or their insurance company. If the ATP refers to a specific provider by name, the injured worker is allowed under Georgia law to see that specific doctor. Often, employers and insurance companies ignore this rule, instead sending the injured worker to a specialist that they picked rather than the one to whom they were referred to by the ATP. When this happens, it is typically because the insurance company wants to use doctors that favor them over injured workers.

Accordingly, the ATP is in control of the case, with regard to necessary medical treatment and work status, and therefore entitlement to weekly income benefits, which is largely based upon work status. To put it simply, your choice of doctor from the panel is a very important decision, typically the most important decision in the beginning of a case.

Why Retaining Legal Counsel Is So Important

Whoever controls the medical treatment also controls the case. That's why it's important to understand the panel, and make a good initial choice, instead of just going along with the employer's suggestion regarding the first doctor to see.

The panels are often filled with doctors who are known to be friendly to insurance companies, not injured workers. Many doctors are even seen as "company doctors,” favoring what benefits the company more than the patient. Unfortunately, these panels can often be filled with these types of doctors, creating a difficult situation for patients. Not all doctors are like this, but without help, the injured worker can find it difficult to determine which doctors are company doctors and which are not.

That is why it is so crucial to consult a North Georgia workers’ compensation attorney after you have been injured. They can help you make an informed choice from a complete panel of physicians. Attorney Kaleita has insight on what to look for in an ATP, how to navigate the panel process, and how to ensure referrals are not ignored by your employer.

Don’t risk getting treatment from a doctor who is more concerned with caring for your company rather than your condition. Call Douglas F. Kaleita, P.C. to get counsel!

Categories: Workers' Compensation