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What can I do if my employer ignores my request for treatment authorization?

After an employee is injured on the job, they are permitted to seek treatment with one of many authorized physicians on a panel.  In some situations, that particular authorized physician may recommend additional treatment or testing from another physician.  When this happens, the employee must file a WC-205 to request the authorization to treat with another physician.

For example, employee gets injured on the job.  She reports her injury to her employer.  Employee seeks treatment with Dr. X who is an authorized physician.  After treating with the doctor a handful of times, he recommends a test that he cannot perform.  It is recommended that the employee treat with Dr. Y in order to obtain the proper treatment which will help the employee return to work.  Dr. X files a WC-205 on December 1, 2008 to request the treatment.  Unfortunately, the employer does not respond to the WC-205.  Can the employee go ahead and treat with Dr. Y or must the employee wait for her employer to give her the authorization?

Since Dr. X was a valid referring physician and was authorized to treat the employee, the employer’s failure to reply to the WC-205 in five business days is a violation of Board Rules and justifies the imposition of a civil penalty under O.C.G.A. § 34-9-18/ Board Rule 205. It would be likely that an ALJ would impose a penalty between $100 and $1000 against the employer for not timely responding to the WC-205.  Failure to timely respond to a WC-205 causes an unfair delay when the employee is waiting for medical treatment.

One more note, if the employee went ahead and treated with Dr. Y after the 5 days passed but before the employer responded to the WC-205, the employer would be responsible for the medical expenses related to the treatment/test of Dr. Y.  Pursuant to Board Rule 205, medical treatments/tests that are prescribed by an authorized treating physician shall be paid if the treatment is related to the on-the-job injury and likely to restore the employee.

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