In a workers’ compensation claim the insurance company will be monitoring the worker’s care plan and progress.  It is in their best interest to “cut you off” of treatment as soon as possible.  Unfortunately, the insurance companies have hand picked their initial line of physicians for you.  Even more unfortunately, sometimes their loyalties may not run to the patient.

In most cases, an injured worker needs the protection of a lawyer who will put the patient’s best interest in front of his own.  It would be best to be represented by a lawyer who exclusively handles and tries workers’ compensation cases.  At the Ramos Law Firm, our attorneys only handle these workers’ compensation matters.  If you have been injured on the job, call our attorneys for a free consultation at 404-355-3431 or click here to contact us now.

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In most cases, the Employer may have a list of medical doctors from which the injured workers may obtain treatment.  These doctors may consist of occupational, orthopedic, or neurological specialists.  The Employer has the burden of having this list of doctors posted in a prominent place.  The Employee has the choice of selecting any doctor on this panel.  Also, the injured worker may also change or switch doctors one time without the Employer’s permission.

The income benefits are determined by averaging the injured employee’s weekly wages from the previous 13 weeks and taking 2/3rds of it. Moreover, the 2/3rds of this average weekly wage is capped depending on the date of the accident or injury. This is called the workers’ compensation rate.  If the injured employee is not making the maximum workers’ compensation rate, the Employer/Insurer is required to outline their calculations for the State Board.  It is important to scrutinize these numbers to ensure proper payment.

These workers’ compensation benefits should be started in a timely fashion as outlined by the law.  If you have been injured on the job and would like to discuss your claim, please contact the Ramos Law Firm for a free consulation with an expert in the field.

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When an employee is injured on the job, he or she is either rushed to the hospital in severe cases or instructed to treat with “Concentra” or “Urgent Care.”  These places are industrial clinics that focus in minor occupational accidents.  If the injury requires more specialized care, the employee is often referred to an “orthopedic” doctor.  The term, ‘orthopaedic’, literally translates to “straightening a child” as if he or she had a broken bone.

Some orthopedists will exclusively focus their practice on particular body parts such as shoulders, knees, hands, elbows, or the spine.  These doctors also are referred to as practicing “sport medicine.”  These physicians may also perform the surgical repairs and may be instrumental in developing and monitoring the coordination of physical therapy and other modalities of recovery.

In the greater-Atlanta area, groups such as the Peachtree Orthopaedic Clinic, Resurgens Orthopaedics, and Dominion Orthopaedics are common players in the workers’ compensation realm.  These groups are often on the Employer’s “panel of physicians.”  It is important to remember that an injured worker has the right to choose his or her doctor from this panel or list of doctors.  Understand that your health is at issue and you should take an active role in the medical care.  It is also very important to know the doctor’s reputation as being a “patient advocate” or someone directed by the insurance company.  It is also prudent to inquire with the State Medical Examiners Board to determine if any of these doctors are in good standing or if they have ever been disciplined by the State.

The ultimate goal of all treatment is achieve a “cure”, or at least get you better to return to work in some capacity.  More often than not, a “cure” is only an ideal.  Lingering pain and chronic discomfort are common symptoms that may last a lifetime.  However, the issue is whether you are able to return to work from a medical standpoint.  Obviously, this is a question for the treating doctor based on the medical evidence.

In some instances, doctors may prematurely release the injured worker back to work when the employee remains disabled.  In these unfortunate cases, the worker is at a disadvantage.  He or she is faced with either risking further injury by returning to work or face a termination (of benefits or the job) for failing to report to the job site.  In these situations, it would be prudent to consult with a lawyer who practices workers’ compensation law.  At the Ramos Law Firm, the consultation is free and confidential.  If you would like to speak to an attorney about your case, please call 404-355-3431 to arrange an appointment.

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The question, then, is what constitutes notice.  On a very obvious level, if the claimant’s counsel calls the employer’s counsel and says “I want Dr. Smith, the doctor who treated my client while the claim was controverted, to be the ATP,” I imagine that would suffice.

But what would be the effect of Dr. Smith calling the adjuster for the insurer to try to authorize an appointment?  Is that notice?  Should the adjuster be required to infer that Dr. Smith is now the authorized treating physician?

What if counsel for the claimant simply sends bills to the employer from Dr. Smith asking for payment?  Is that notice?  When does the notice take effect?  Should the employer pay for the bills?

The obvious answer is to avoid all of these questions.  The claimant’s counsel should write a letter to the employer’s counsel setting out the claimant’s intention to name Dr. Smith as the ATP.  It takes all of the guesswork out and avoids unnecessary litigation.

If your claim has been controverted and you are attempting to get medical treatment, please contact an attorney with the Ramos Law Firm.  We are here to help Georgia’s injured workers.

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O.C.G.A. § 34-9-201(b)(1) provides:

The physician selected under this subsection from the panel may arrange for any consultation, referral, and extraordinary or other specialized medical services as the nature of the injury shall require without prior authorization from the Board; provided, however, that any medical practitioner providing services as arranged by a primary authorized treating physician under this subsection shall not be permitted to arrange for any additional referrals.

As the statute clearly reads, an authorized treating physician can make a referral for specialized care to any other physician.  This is not limited to the posted panel of physicians.  The only limitation is that the physician to whom the injured worker is referred may not then make another referral.  Rather, that physician must consult with the authorized treating physician for any further referrals.

The question then arises – can the employer refuse to authorize treatment from a physician who is referred by the authorized treating physician?  The short answer is generally not.  Should the employer fail to authorize treatment from the referred physician, that would certainly draw a hearing request from the claimant’s attorney.  The employer, then, would have the burden of showing that the treatment was not necessary.  Presumably, this would require opinions of other physicians to combat the referral.  Absent any such evidence, it would likely be deemed unreasonable for the employer to refuse to authorize such treatment thereby subjecting themselves to assessments of attorney’s fees.

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1. a Traditional Panel of Physicians;
2. a Conformed Panel of Physicians; or
3. a Workers’ Compensation Managed Care Organization (WC/MCO).

The requirements regarding what types of medical professionals are listed, how many medical professionals or medical facilities are listed differ for each type of panel.

Although the Georgia Workers’ Compensation Act has different requirements for each type of panel of physicians, the care provided to the injured worker receives remains consistent.

Quite frequently, employers utilize either a Traditional Panel of Physicians or a Conformed Panel of Physicians.  Since the WC/MCO is less frequently used by employers, very few individuals understand a WC/MCO Panel.  If an employer elects to contract with a WC/MCO to provide treatment for its injured employees, the employer must make sure the WC/MCO is certified by the State Board of Workers’ Compensation pursuant to O.C.G.A. § 34-9-208 and the corresponding Board Rule.  The application process for certification of a WC/MCO is outlined in O.C.G.A. § 34-9-208.

The State Board of Workers’ Compensation has mandatory requirements for a WC/MCO Panel.  For example, a WC/MCO Panel must have minority providers and must have the following providers listed in their Panel:

1. internists,
2. family practice,
3. orthopedic surgeons,
4. neurologists,
5. general surgeons,
6. chiropractors,
7. physical and occupational therapists,
8. psychologists or psychiatrists,
9. diagnostic pathology or laboratory services,
10. radiology services and hospital,
11. outpatient surgery, and
12. emergency care services.

Please see Board Rule 208(a)(1)(e).

The State Board also requires certified WC/MCOs annually report an updated list of providers in their network, any sanctions taken against the WC/MCO or providers in its network, reported complaints and summary of dispute resolution proceedings.  A WC/MCO’s reporting requirements provide employers and its employees with information about the providers who are providing treatment, which ensures employees receive quality treatment.

No matter which panel is chosen, O.C.G.A. § 201 requires employers post the panel in a location that is visible to all employees.  If using a WC/MCO, employers must educate employees on how to seek medical treatment when injured on-the-job.

Although the WC/MCO is quite different from the Traditional or Conformed Panel of Physicians, the State Board of Workers’ Compensation requires that WC/MCOs are certified and monitors these panels in order to ensure medical treatment rendered to injured workers remains consistent.  If you have additional questions regarding WC/MCO panels, please contact the attorneys at the Ramos Law Firm.

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It is well established in Georgia that if an employee continues to perform his duties until he is forced to stop work because of the gradual worsening of his condition, that employee may be granted a new date of injury when his disability begins.  The gradual worsening of the condition must be at least partly attributable to the physical activity in continuing to work for the employer after the original injury.   In the eyes of the law, it is unfair to penalize the employee for continuing to work despite his injury.  Therefore, the law allows for a new fictional date of injury which is the date the disability begins.  In the example above, the employee would have “suffered a new injury” in 2006 when his doctor recommended that he no longer work.  Under this rule, the employee will have the opportunity to obtain his full income benefits.

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This is the Employer/Insurer’s preapproved list of doctors for workers’ compensation injuries.
Georgia Law O.C.G.A. § 34-9-200 requires an employer to maintain a list or panel of six (6) different physicians, professional associations or corporations of physicians that an employee must select from to treat his on the job injury. At least one of the six physicians must be an orthopedic surgeon and no more than two (2) professional associations or corporations of physicians can be industrial clinics. The State Board further stresses that if the company is located in an area where it is feasible, minority physicians should be included as an option.

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