After suffering a work-related injury, you may require emergency medical treatment, physical therapy, surgery, pain management, and more. Workers’ compensation benefits can cover your necessary medical expenses, as well as a portion of the wages you miss while you are unable to work.
When you are injured on the job, you may wonder if you can see any doctor you choose for your workers’ comp claim in Georgia.
After an injury, many people want to see their primary care physician. But, in Georgia, your employer chooses a group of physicians approved to treat workers’ comp cases. These doctors are part of a physician panel or a Workers’ Compensation Managed Care Organization (WC/MCO).
Gregory Smith Law, LLC is solely focused on helping workers move forward following an on-the-job injury. We’re here to answer your questions and help you navigate each step of the workers’ compensation process.
Let us fight for your rights and the quality medical care you deserve. Contact us today for a free consultation.
Do Employers and Insurance Companies Control Workers’ Compensation Medical Treatment in GA?
The answer is “yes and no.” Workers’ compensation insurance companies are responsible for paying for various medical benefits after an on-the-job injury. Insurance companies and employers must offer injured workers one of two ways of choosing a physician for treatment.
- Your employer may have established a Panel of Physicians that has at least six doctors, one of whom must be an orthopedic surgeon. This list of doctors must be posted in a prominent place on the employer’s premises. The doctor selected from the panel of physicians becomes the Authorized Treating Physician. An injured worker has the right to make a one-time change of physicians from one panel doctor to another without the approval of the employer/insurance company.
- A Self-Insured Employer may use a WC/MCO approved by the State Board of Workers’ Compensation. This offers you a greater choice of approved physicians. The employer must post a 24 hour toll free number for the Managed Care Organization.
In case of an emergency, you are allowed to seek emergency medical treatment. Your employer will pay for temporary medical care at the nearest emergency location in an actual emergency. Once the emergency is over, you must see a doctor from the panel of physicians or MCO. That doctor then becomes the authorized treating physician.
If the employer does not maintain a properly posted Panel of Physicians, or work with a WC/MCO, the employer/insurer forfeit the right to control the injured worker’s medical treatment. The employee may then choose any doctor they want and all medical treatment provided by that doctor must be paid for by the employer/insurer.
What About Referrals to Other Medical Providers?
After an on-the-job injury, you may require care from various healthcare providers to help with physical therapy, imaging studies, testing, and surgery. Your authorized treating physician is allowed to make these referrals.
The authorized treating physician you pick from the posted panel of physicians can arrange for any consultation, referral or other specialized medical service to treat your work injury without prior authorization from the Georgia State Board of Workers’ Compensation.
Can I Pick a Doctor for Another Opinion?
There are certain instances when you can request a second opinion that your employer must pay for. In some cases, your injury or treatment may not be straightforward. In Georgia, you have the right to ask for an independent medical examination under certain conditions. To meet these conditions, you must:
- Have had an accepted on-the-job injury.
- Have received workers’ compensation income benefits within the past 120 days.
- Have the examination performed by a duly qualified physician or surgeon.
- Notify the employer or insurance company in advance.
The employer or insurance company will only pay for one independent medical evaluation, so it is important to use this examination wisely. It’s also important to know that this doctor can offer a second opinion about your condition, but cannot treat you. If you are petitioning to change physicians, you can use this evaluation to support your claim.
Another way to get a second opinion is if your authorized treating physician requests one. In this case, the insurance company must pay for the referral. To have the second opinion paid for, the referral must come from your approved doctor, who must choose the doctor who gives the second opinion. The insurance company will pay for more testing in the second opinion only when your approved doctor agrees with the recommendation.
Should I Pay for a Second-Opinion Evaluation Myself?
You have the option of paying for a second opinion yourself. This can be challenging since medical care is expensive. However, a second opinion may give you the information you need to get a change in your treatment plan approved or support your claim for a change in your authorized treating physician.
How to Know When You Need Legal Help with Your GA Workers’ Comp Claim
Navigating a worker’s compensation claim can be complex and frustrating. In many cases, your injury may prevent you from adequately representing yourself and seeking the best possible outcome in your case. After an injury, it is vital to protect your rights.
With more than 25 years of experience, the Augusta workers’ comp lawyers at Gregory Smith Law, LLC have the skills and experience to evaluate your claim and help you seek the wage replacement and medical benefits you need after an on-the-job injury.
Call our office today for a free consultation with our team and get the legal advice you need to protect your rights and future.