Georgia Workers' Compensation Lawyer Blog

Sometimes, for no apparent reason, a workers' compensation insurance company will decide that a referral for surgery or for additional treatment with another doctor, even when the recommendation or referral came from the workers' comp authorized treating physician, is not authorized. Often, we see this when the recommendation is for pain management, psychiatric care, or surgery. Instead of allowing the injured worker to see the expert his workers' comp doctor suggests, the insurance company will want him to go much farther away to a medical provider of its choosing instead.

Under Georgia Workers' Compensation Rule 200(b)(2), there are a few factors a court will consider when deciding whether the insurance company's requested change in doctors is of benefit to the injured worker:

1) proximity of the doctor to the injured worker's home
2) accessibility of the doctor to the worker
3) excessive/redundant performance of medical procedures previously given
4) necessity for specialized care
5) language barriers
6) referral by the authorized treating physician
7) noncompliance of the doctor with board rules
8) who's on the panel of physicians
9) duration of treatment without improvement
10) number of prior treating doctors
11) prior requests for changes in treating doctors
12) if the worker was released to regular duty by the authorized treating doctor
13) if the current doctor has nothing more to offer.

If your "workers' comp doctor" has referred you for treatment with another specialist or at another facility, and the workers' comp adjuster is denying it or has filed a motion through a defense attorney for a change in physicians to keep you from treating with the doctor to whom you were referred, call our Atlanta injury lawyers' office for assistance with filing an objection and/or a hearing request with the State Board of Workers' Compensation so that you can fight for the medical care your doctor wants you to get instead of the medical care your employer's insurance company wants you to get.

Recently, a workers' compensation client of mine whose authorized treating physician ordered surgery went into the doctor's office for the "pre op," got mentally and physically ready for the surgery, showed up for the procedure, and then learned that the insurance adjuster had called her doctor's office to cancel it.  No reason was given; the adjuster just didn't want to pay for her to get better.

Then, the insurance company ordered an IME:  an "independent" medical examination. The reason "independent" is in quotes is because these evaluations are hardly independent at all, but are usually the insurance company's attempt to pay for a doctor to write that the injured worker is lying and has nothing wrong with her. However, since the client is receiving TTD (temporary total disability) benefits, she has to attend the appointment.

Below is a video that humorously shows what can be expected at an IME:



If your workers' comp adjuster has sent you notice that you are to attend an IME with a doctor of their choosing, attend the appointment, bring any x-rays, MRIs, and other films you have, and be polite and honest during the evaluation.  Just don't expect it to bring anything good to your medical health or your claim. 

For help with learning the reputations of doctors frequently used for accident claims insurance company IMEs, contact my office via the below contact information:
 
Moebes Law, LLC
3535 Piedmont Road NE
Building 14, Suite 410
Atlanta, GA 30305
(404)354-5432

If your Georgia workers' compensation claim is compensable, your employer and/or its workers' compensation insurance company will pay for your medical expenses when traveling to authorized medical providers. This can include the following expenses:

• mileage (currently $.40/mile) to and from the doctor's office, physical therapist's office, and pharmacy
• parking at the medical providers' offices
• meal expenses (up to $30/day) when the trip to the doctor takes more than 4 hours 
• lodging and meals when the medical visit is outside your home city.

You have one year to submit your medical expenses related to your treatment; otherwise your right to be reimbursed is waived.  The employer/insurer have 30 days to pay these expenses; otherwise, penalties and interest will accrue.

For additional help with Georgia workers' compensation law, please contact our Atlanta law office:
Moebes Law, LLC
3535 Piedmont Road NE
Building 14, Suite 410
Atlanta, GA  30305
(404)354-5432

If you're receiving temporary total disability benefits for your Georgia workers' compensation claim, you need to attend the medical appointments scheduled with the doctor from the panel of physicians, or the agreed-upon authorized treating doctor. Otherwise, the workers' comp insurance company may request that your disability benefits be suspended for failure to cooperate with medical treatment.

More than likely, they will file a motion to compel your attendance at the doctor appointments first, and then they will pursue suspension of TTD benefits. If getting to the doctor is a concern, you can request transportation to and from the treating doctor's office (or mileage reimbursement if you drive yourself). Please call Moebes Law, Atlanta workers' compensation attorneys, for more information on medical benefits and Georgia workers' compensation issues.

Injured workers in Georgia should be directed to a panel of physicians immediately after reporting a workplace injury, in accordance with the Georgia Workers' Compensation Act.  In most instances, the panel must contain six doctors or medical facilities from which an injured employee can choose a treating doctor. 

Often the piece of paper containing these six medical providers is pink, making it easy to distinguish from other notices that may be on display.  The panel is frequently found near a timeclock, in a breakroom, or in an otherwise centrally-located room or office. 

The functions of the panel of physicians should be explained to all employees shortly after they are hired, so that in the event of an accident at work, the injured worker will know where to go for medical care.

Please feel free to contact me, an Atlanta workers' comp attorney, with any questions you may have about medical treatment after an injury at work.