Who Picks the Doctor in a Georgia Workers Comp Case?

In Georgia, a frequent question that arises between both employers/insurers and injured employees is- who gets to pick the doctor or clinic to treat the injured employee for the on-the-job injury? Sometimes employers believe they can send the injured employee for treatment to the clinic or doctor of the company’s choice. By the same token, injured employees sometimes believe that they will be allowed to treat for the on-the-job injury with the doctor of their choice, often their own family physician. However, ordinarily, neither approach is the correct means of selecting a treating physician in compliance with Georgia law.

Panel of Physicians

Georgia does provide for conformed panels of physicians and certified workers’ compensation managed care organizations. However, most employers have a non-conformed (or "traditional") panel of physicians. Employers are required to post the panel of physicians in "prominent places upon the business premises". Often, an employer will post the panel of physicians in an employee break room, near a time clock, or on a bulletin board beside other required notices to employees. Although no longer required, many employers print the panel of physicians on a pink sheet of paper.

Through requiring a panel of physicians, a balance is struck between the competing desires of employers/insurers and injured employees in selecting the treating physician. Rather than allowing the injured employee to select any physician of his choice or the employer requiring the injured employee to treat with only one doctor or clinic of the employer’s choice, the injured employee is allowed to initially treat with any physician or clinic that is listed on the panel of physicians. The injured employee is also allowed to change once from any treating doctor on the panel to another panel doctor without prior authorization from the State Board of Workers’ Compensation.

A traditional panel of physicians is required to have a minimum of six unassociated physicians/clinics. Of this minimum number, there is required to be at least one orthopedic surgeon and no more than two “industrial” clinics. At least one minority physician is required to be on the panel (although the State Board can grant exceptions to this requirement).

Other Means of Obtaining Authorized Treating Physician Status

Usually, the first physician selected by the injured employee off the panel is considered to be the "authorized treating physician." There are a number of situations where an injured employee can petition the State Board to deem a non-panel physician to have authorized status to treat the claimant under the Workers’ Compensation Act. Examples of these situations include where:

An injured employee had to seek emergency treatment related to the on-the-job injury;
The authorized treating physician refers the injured employee to another physician for treatment;
A panel of physicians was not posted in a "prominent" location;
The panel of physicians did not have the proper number or types of doctors/clinics;
The employer did not take appropriate steps to inform the injured employee of the function of the panel including the injured employee’s right to select a physician of his choice off the panel;
The employer did not give the employee necessary assistance in contacting panel members;
The employer or insurer has refused to provide or pay for treatment related to the on-the-job injury;
An authorized treating physician has refused to provide treatment to the injured employee;
The employer/insurer has controverted liability on the workers compensation claim (such as through filing a Form WC-3) and the claim is later found by the Board to be "compensable" (meaning that the injury qualified for benefits under the Workers Compensation Act despite the employer/insurer having controverted the claim).

Additionally, the employer/insurer and the injured employee may agree on a non-panel authorized treating physician. The injured employee can also file a motion or request a hearing with the State Board to change the authorized treating physician based on any number of factors related to the change benefiting the injured employee or providing the injured employee with appropriate and beneficial medical care.

Other Pointers for Injured Employees Initially Seeking Medical Treatment

With all on-the-job injuries, injured employees should try to inform their employer through a supervisor as soon as possible of the on-the-job injury. Informing the employer of the on-the-job injury promptly will, hopefully, allow the injured employee to seek medical treatment before the injury worsens. Injured employees should be particularly cautious about filing their medical expenses for an on-the-job injury through their group health insurance rather than through their employer and their employer’s workers’ compensation insurer (if any). In many instances, a group health insurer will refuse to pay for medical treatment caused by an on-the-job injury which could leave the injured employees stuck with unpaid medical bills.

Protecting Your Rights

Injured employees should keep their rights regarding selecting a treating physician discussed above in mind. As always, if an employee injured in Georgia has questions or concerns about his rights in selecting and seeing a physician or clinic for medical treatment related to the on-the-job injury, he should seek advice from an attorney practicing in workers’ compensation so that his rights will be protected.

From the author: Atlanta Workers Compensation Lawyer

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