Georgia’s workers compensation laws allow you to pick your workers’ compensation doctor. It is important to understand that you may have a limited number of doctors from which to choose. The doctors from which you can choose will depend on whether your employer has followed the rules about posting a list of doctors and explaining that list to you.
Do employers and insurance companies control workers’ compensation medical treatment?
Many people who suffer a work injury get told by their employers that they have to go to a certain doctor. Insurance companies often tell people the same thing. They try to say that they have “control” over medical treatment.
That is not true.
Georgia workers’ compensation law gives your employer some input into your workers’ compensation doctor (otherwise known as your “authorized treating physician”). But, that input is very limited.
The law requires your employer to post a list of workers’ compensation doctors. This list is usually called a “panel of physicians”.
That is all the control that your employer gets. Basically, they get to limit your choices, but you get to choose which doctor on your employer’s list will be your doctor.
Some employers do not post a list. Other employers post a list but do not follow all of the detailed workers’ compensation rules.
If this is the situation in your case, it is usually a great benefit for you. In these situations, you can almost always pick any doctor that you want to serve as your authorized treating physician for your work injury.
What about referrals to other medical providers?
Many employers and insurance companies try to control referrals to other medical providers. They tell injured workers that they have to go to a certain physical therapy location or a certain MRI facility. They say that you can only get prescriptions from certain pharmacies. If the authorized treating physician refers to a specialist, the insurance company often tries to control which specialist the injured worker sees.
Some insurance companies even try to say that certain medical providers or doctors are not in their network. They will tell doctors that they have to refer to someone in the insurance company’s “network”.
This is simply not true.
Georgia workers’ compensation law gives your authorized treating physician control over your medical treatment. Networks are a creation of the insurance companies. The authorized treating physician can refer you for whatever treatment you need.
The authorized treating physician picks the doctors, the physical therapists, and any other medical providers you see. The insurance company’s “networks” do not control the authorized treating physician’s referrals (unless your case is one of the very small number of cases where medical care is provided by a State Board approved WC/MCO instead of a traditional panel of physicians).
Sometimes, your authorized treating physician will refer you without specifying a particular medical provider. He or she will just write a referral for “physical therapy” or “neurological treatment” or something like that. In this situation, you should be able to schedule the treatment where you want it to occur.
The insurance company will often try to prevent you from doing this. They will say they control the medical treatment. They do not. It is your injury, your body, and your treatment.
Can I get pick a doctor for another opinion?
As we have mentioned in previous blog articles, the Georgia workers’ compensation system provides a few ways to get an evaluation by a different doctor. You can change doctors on the panel of physicians, change doctors by agreement, or file a request to change doctors. In addition to those options, there are also some options that allow you to get evaluated by a doctor without changing doctors.
O.C.G.A. 34-9-202 Evaluations
One way of getting another medical evaluation to use O.C.G.A. 34-9-202. An O.C.G.A. 34-9-202 evaluation is often referred to as an IME or “independent medical evaluation”. When you have received weekly workers’ compensation benefits (either temporary total, temporary partial, or permanent partial disability benefits) within the last 120 days, you have a right to an evaluation by a doctor of your choosing. There are a few important things to understand about this evaluation:
- You can only get the insurance company to pay for one 34-9-202 evaluation in your entire case so use it wisely - The doctor can only evaluate you, not treat you (but you could use the evaluation in a motion to change doctors) - The doctor can order reasonable and necessary testing in the evaluation (which the insurance company will probably have to pay for if it has not been done before)
Second Opinions
A 34-9-202 evaluation can be useful if you do not feel your current treating doctor is helping you get better or you just want another opinion about some recommended medical treatment. However, in certain circumstances, you can get another opinion without using your one time 34-9-202 evaluation.
If your authorized treating physician refers you for a second opinion, then the insurance company will have to pay for that referral. The second opinion will be very similar to the 34-9-202 evaluation, but there are a few important differences:
- You must have a referral from your authorized treating physician to get a second opinion evaluation - Your doctor (not you) generally chooses the doctor for the second opinion - The insurance company will not have to pay for recommended testing by the second opinion doctor unless your authorized treating physician agrees with the tests that are recommended and sends you for those tests
Paying for the Evaluation Yourself
A final way to get an evaluation by another doctor is to just pay yourself. While this gives you the freedom to see any doctor you want, it is obviously difficult to do.
Medical treatment is expensive. However, if you have the money and want to pay for an evaluation yourself, you can certainly do that. If our firm represents you in your case, we will often pay for a medical evaluation if you need one.
Need Help?
Being able to pick a good doctor is critical to getting proper medical treatment. Getting proper medical treatment is critical to recovering from your injury.
If you are having difficulty picking a doctor or getting medical treatment, we will gladly provide you with a free consultation. Just read this short article to find out more about how a free consultation works, what you can learn, and how to set one up.
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