SCRIPT FOR MEDICAL TREATMENT OPTIONS IN A WC CASE
This is an excerpt from one of the recent episodes of 'Do I Need a Lawyer?' hosted by: Gary Martin Hays.
"Hi Gary. I have a question for you about my workers' compensation claim. I have a lower back injury from lifting a heavy box onto my work truck. The doctor sent me for an MRI and he is telling me I have a herniated disk. I am scheduled for epidurals next week. All of this is a bit overwhelming. I haven't been able to work in a month. These medical bills are going to be crazy expensive. My wife and I are worried about all of these bills - not only now, but in the future. Who pays for the medical bills? The surgery if I need it? Honestly - I'm lost.
Do I need a lawyer?
-Sam G. in Atlanta
Sam, thanks for your email.
I'm sorry about your injury and that you are going through this.
Worker's compensation claims can be very overwhelming.
To answer your last question, Yes! You do need a lawyer.
Let me bring in Kellie Henson to help us address this question in more detail. Kellie is a supervising attorney in my law firm's workers'compensation division.
Gary: Kellie, I think it would be good to give Sam and all of our viewers a brief summary of what medical benefits an injured worker can receive under Georgia's Workers' compensation Act.
Kellie: Georgia law requires employers and insurance companies to pay for medical treatment that "shall be reasonably required and appear likely to effect a cure, give relief or restore the employee to suitable employment".
Kellie: But the law puts some conditions on this medical treatment. The Insurance company, to some extent, can control who provides medical treatment to the injured worker. By law, the employer has to post a "panel of physicians" at your work site. It is usually pink in color and located in the break room area at your workplace.
Kellie: If you are hurt on the job, you must select one of the doctors on the panel to provide treatment to you.
Gary: What if the employer doesn't have a panel of doctors posted?
Kellie: Then Georgia law tells us the injured worker is free to select the physician of their choice to provide treatment to them. And you will be surprised though how many employers "suddenly" claim the panel of physicians was posted once they talk to their insurance company.
Gary: What if the employer has a panel? Are there requirements that they have to meet with this panel of physicians?
Kellie: Yes. The law requires the panel must have at least six doctors listed on it. There must be at least one orthopedic surgeeon, and no more than 2 occupational clinics.
Gary: What happens if the panel does not have six physicians? Or an orthopedic surgeon?
Kellie: Georgia law gives the injured worker the freedom once again to select THEIR doctor to provide treatment. But I must advise everyone watching this to know - you really should not try to make this determination on your own as there are great risks and exposure if you don't handle this physician selection properly. You could be responsible for these medical bills if you aren't careful.
Gary: Kellie, how important is the authorized treating physician under our workers' compensation laws in Georgia.
Kellie: Gary, this is one of the most critical decisions an injured worker can make. We immediately ask for a copy of the panel of physicians that was allegedly posted so we can assist our client in making the decision about which doctor should provide treatment.
Gary: This is where an experienced attorney in the workers' compensation arena is so important. When you have handled as many claims as our firm has for injured workers, you get to know who the doctors are that truly care about a patient, versus the doctors that only do what the insurance companies tell them they can do.
Kellie: Every injured worker deserves to be treated with dignity and respect by a doctor that is concerned about correctly diagnosing what is wrong with the patient, and then treating those injuries.
Gary: Are injured workers ever allowed to change treating doctors?
Kellie: Yes. If your Employer properly posted a valid panel of doctors at work, then you are entitled to a one-time change in treating doctors from the doctors that are listed on that panel.
Gary: One final thing to quickly discuss. Can our clients get a second opinion from someone that is not a workers' comp doctor?
Kellie: Georgia law allows a one-time Independent Medical Evaluation, or what we refer to as an "IME". You can select a doctor of your choice to perform this one-time evaluation and have it paid for by the insurance company. In order to be entitled to the IME, you must have received weekly workers' compensation checks within the last 120 days of the time you are requesting the IME option.
Gary: Thanks for your help Kellie.