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Changing doctors in the workers’ compensation claim

If the injured worker desires to change physicians within the posted panel of physicians, he or she may do so without approval from the Board or the insurance company.  This change is only allowed one time, however. If the injured employee wants to change physicians to someone not listed on the panel of physicians, he or she must either find a doctor the insurance company will agree to, or formally request the change from State Board of Workers’ Compensation.  See, O.C.G.A. 34-9-201(e).  This holds true if the insurance company wants to transfer care from the established treating physician to another physician.  For example, if the insurance company desires to transfer care away from Dr. Erik Bendiks to Dr. Hal Silcox, it must either convince the injured worker to agree to the change or present evidence to the State Board justifying the change.  This change has tremendous impact on the claim and should not be taken lightly.

If the claim is accepted by workers’ comp and the injured employee treats with an unauthorized doctor, the cost of that treatment will not be covered by the workers’ compensation insurance carrier.  However, the presiding judge may rely upon the unauthorized physician’s reports to find that the employee may be disabled or entitled to benefits.  Georgia Baptist Medical Center v. Moore, 219 App. 171 (1995).   Conversely, the judge may also rely on the unauthorized doctor’s reports to deny the claim.

If the injured worker’s claim is denied or “controverted”, the injured employee can seek treatment with whomever he chooses.  Board Rule 201(b).  However, this treatment will not be paid for by the insurance company unless the State Board orders payment or the insurance company voluntarily pays.  Generally, this issue will come before the State Board and the claimant will bear the burden of demonstrating that the injury arose out of and in the course of his or her employment.  If the injured employee is successful, the costs for the treatment incurred will likely be covered by the presiding judge’s award.

Settlement in Workers’ Compensation Claims

The term “settlement” can be very confusing in the Georgia workers’ compensation field.  Essentially, a “settlement” is an agreement between the parties where one party receives financial compensation in exchange for releasing the other party from any further obligations or threat of prosecution.  Additionally, a settlement will likely incorporate a formal separation of employment.  At the Ramos Law Firm, we believe that “timing” is very important when considering whether an injured worker should entertain the settlement of his or her case.  We believe that settlement cannot be forced or rushed in an accepted workers’ compensation claim as the injured employee must consider his or her health first.  Generally, our firm believes that the insurance company should be held to provide the injured worker with quality medical care until the condition improves.  However, every case is different.

The value of the settlement depends on many factors.  Some likely factors affecting the settlement value of any case include the severity of the injury; the authorized treating physician’s opinion as to disability and future medical treatment; the injured worker’s average weekly wages; and the ability of the Employer to return the injured work back to work.  Again, no two cases are exactly the same and the value of the potential settlement is very fact sensitive.  It is important to note that the State Board does not have authority to mandate a settlement in any case.  The parties must mutually agree to settle the case.  In other words, the Court cannot order the insurance company or the injured worker to enter into a settlement agreement.

Obviously, the determination of whether to settle the case and for how much deserves a thorough analysis of the medical records, wages, and applicable facts of the case.  Contact the Ramos Law Firm for a free consultation.

Physical Therapy in Workers’ Compensation Claims

After a physical injury at work, the employer is required to furnish the injured employee medical benefits which include medical, surgical, psychological, and other related or derivative treatment at hospitals and physical therapy facilities.  See, O.C.G.A. §34-9-200(a).  The employer/insurer will be entitled to enjoy the State Board of Workers’ Compensation fee schedule for the payment of these services.  The injured worker should not be charged for this related treatment and he or she should be entitled to transportation or mileage reimbursement.

With particular regard to physical therapy, these sessions should be prescribed by the authorized treating physician.  This type of physical treatment is aimed at improving mobility and to relieve pain.  It also strives to improve or restore physical functioning after an injury.  Moreover, physical therapy should improve the injured worker’s fitness level.   In many workers’ compensation cases, the recommended treatment plan will often require physical therapy either before and /or after surgery.   Physical therapy is common in workers’ compensation cases involving spinal injury cases (neck and back) as well as work injuries involving shoulder and knee tears.  Physical therapy may be done at clinics (HealthSouth or Resurgens) or hospitals (St. Joseph’s or Northside).  It will almost always include a “home exercise” component as well.

In the workers’ compensation setting, it is very important that the injured worker attend and attempt physical therapy.  At the Ramos Law Firm, we firmly believe that your health is at the utmost importance, and you must do everything you can to restore and improve your physical condition after a work injury.  It is important that the injured worker have a good working relationship with the physical therapist and understand they are there to help you “get better.”  However, if the physical therapy is not working, there is no need to injure yourself more.  Be open and honest with the therapist and keep him or her informed of your pain at the clinic, as well as how sore or tired you become at home.  These physical therapy facilities function on information provided by the patient and what they observe during the “work out” or “session.”  In many cases, the injured employee may also undergo massage therapy or aqua therapy as a part of the overall treatment plan.  The authorized treating physician should review the physical therapist’s reports and incorporate those findings in how your future treatment plan should be formulated.

If you have any questions about physical therapy and workers’ compensation, feel free to contact the Ramos Law Firm.

Guidelines for following up with the authorized treating doctor

Generally, the goal of the injured worker and the authorized treating physician should be the same:  to heal the patient.  Given the number of patients that “company doctors” see, it is important that the injured worker serve as his or her best advocate during the medical appointments.  At the Ramos Law Firm, we recommend that the injured employee attend all the scheduled medical visits without fail  However, if you legitimately cannot attend the appointment, notify the physician’s office immediately.  Do not simply “no show”.   Also, call if you are going to be late.   If the doctor or insurance company believes you are refusing medical care, then this may inhibit your entitlement to future care or other workers’ compensation benefits.

When you meet with the treating doctor, have a notebook and pen with you.  We recommend that you write down all your questions before the appointment and make sure you ask him or her for the answers.  As the doctor is answering, take notes as to what the doctor or nurse said in response to the questions.  Also, we recommend you use this “notebook” as your medical diary with relation to your workers’ compensation injuries.  Write down everything you think may be useful.  For example, write down the name of the doctor and nurse, the medical group, the address of the medical facility, parking charges, medication, the level of pain, symptoms or complaints made to the doctor or nurse, and the length of time the doctor spent with you.  These little bits of information may be tedious at first but it may prove to be crucial if there is a dispute down the road.

Additionally, we recommend that the injured worker attend with a trusted family member.  By doing this, it will hopefully cut down on misinterpreting the doctor’s and nurse’s instructions.  If English is not your first language and you prefer an interpreter to assist with the medical evaluation, ask for it.  Don’t be embarrassed or shy about it.  It is your health at stake. On the other hand, the Ramos Law Firm does not recommend you allow anyone from the insurance company attend your medical appointments.  This includes “nurse case managers” or “nurse consultants”.  These people are simply agents of the insurance company and their loyalties run to the insurance company, not the patient.  Remember, you must be actively engaged in your medical treatment as no one else is more qualified to speak about your health issues and complaints.

If you have any questions  about following up with the authorized treating doctors in Atlanta, Decatur, or anywhere in Georgia, please feel free to contact the Ramos Law Firm for a free consultation.

Preparing for Medical Appointments

Getting healthy again from a work related accident should always be the top priority.  Therefore, it is crucial that the injured worker makes the most of his or her time with the physician.  If the injured employee has the panel of physicians, thoughtful consideration must be exercised upon selecting the authorized treating physician.  This doctor holds a good deal of power.   The injured worker should research the potential physicians and ask for advice from more knowledgeable resources such as the Ramos Law Firm.  It is important not to simply accept where the Employer or insurance company  sends the employee.

When the employee attends the medical appointment, it is important that he or she gives an accurate description of the symptoms and painful areas.  Many times, the physician or nurse will ask the injured employee to rate the pain she is experiencing.  Level 1 generally equates to “no pain” while Level 10 equates to “the most pain.”  It is important not to exaggerate.  Level 10 may necessitate a call for an ambulance.  On the other hand, there is no need to hide symptoms or be stoic.  The physicians should be there to help.  At the Ramos Law Firm, we recommend that injured employees keep a journal or diary of symptoms.  Write them down regularly so that you will have data to present to the doctor.  Also, write down the mileage from the employee’s residence to the medical facility.  This includes therapy and pharmacy visits.   These notes should be relatively detailed.  However, we do not recommend writing anything down that you don’t want someone to read.  Additionally, we recommend that the injured worker request a copy of the medical narrative or note pertaining to the medical appointment.

The doctors visits should be used to analyze the data the injured worker presents, not to discover or “fish” for the symptoms.  The patient should be prepared to discuss the data and ask thoughtful questions as to what the physician recommends.

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On this day, the Ramos Law Firm takes a few moments to remember the legacy and lasting contribution of Dr. Martin Luther King, Jr.   As Dr. King stated, “injustice anywhere is a threat to justice everywhere”, we pledge to continue to achieve the promises of equality and freedom.  We wish you a peaceful and meaningful holiday.