Ramos Law Firm Workers' Comp Blog » medical exam

Georgia’s Injured Employees and Workers’ Compensation

Bryan Ramos — Mon, 17 Aug 2009 02:13:22 +0000

Generally, when an employee is injured in Atlanta or any other city in Georgia, the employee may be entitled to workers’ compensation benefits. These benefits are primarily made up of medical treatment as it relates to the work injury and income benefits to a certain point.

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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Georgia Workers’ Compensation Changes in 2009

admin — Tue, 14 Jul 2009 10:36:41 +0000

Earlier this year we wrote about the proposed changes to the Georgia Workers’ Compensation Act. These changes have now taken effect.

Following are some of the changes:

Allowing the ICMS email system to serve as the “notice” and “service” vehicle for ALJ Awards. The bill also contemplates the “issuance” of awards via email will be recognized as notice and service to the parties for appellate matters.

The medical release language has been broadened and it’s possible that an employee’s psych recods may be produced. Click here to see a full copy of original post outlining some of the changes with examples.

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Required “Notice” under Rule 201(b)

James Timmons, Jr. — Mon, 13 Jul 2009 18:06:08 +0000

If an Employer/Insurer has controverted a workers’ compensation claim and the claim is later found to compensable, Board Rule 201(b) provides that “the employee is authorized to select one of the physicians who has provided treatment for the work-related injury prior to the acceptance of compensability, and after notice has been given to the employer, that physician so selected becomes the authorized treating physician.”

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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My doctor considers my injuries disabling, another doctor does not, who has the final say?

Julia Lindsey — Sat, 11 Jul 2009 18:51:04 +0000

In many situations, an employer and an employee will present conflicting testimony and evidence. For example, an employee’s treating physician might classify an employee’s injury as disabling and catastrophic. The employee will never to be able to work again. While a doctor for the employer, who has had the opportunity to examine the employee, might present a less severe diagnosis that will allow the employee to return to work. Both doctors are well respected in the community, but one is more liberal or conservative than the other. What happens in this situation?

As a general rule, in workers’ compensation claims, although all medical opinions must be considered, acceptance of an opinion is not required. The weight and credit to be given to expert testimony, such as a doctor, is a question for the fact-finder or judge. The Board of Workers’ Compensation may accept testimony of one doctor over another doctor. In the situation presented, the Board or administrative law judge will be in the best position to examine all of the evidence and determine the credibility and weight of the evidence. The Board or administrative law judge will decide which doctor’s medical testimony to accept.

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State Employees are eligible for workers’ compensation benefits

Bryan Ramos — Tue, 30 Jun 2009 11:13:50 +0000

It is not surprising that the largest employer of Georgia workers is the State of Georgia itself. The State of Georgia has dozens of agencies from the State Accounting Office to the Department of Transportation. Under the workers’ compensation code, state workers are included as eligible employees for benefits should they be injured on the job.

Not unlike any other injured worker, the state employee who is injured on the job, either by a traumatic accident such as a prison guard being attacked by an inmate or by a repetitive or cumulative motion injury such as carpal tunnel syndrome that a clerical assistant or worker at the State Personnel Office may incur, may be entitled to weekly benefits and medical treatment. The threshold questions are (1) whether the worker was in fact an employee of the State, and (2) whether the accident arose out of and in the course of employment. The answers to both questions must be “yes.”

As another general example, should an officer with the Georgia State Patrol be injured as a result of a car accident when chasing a criminal or shot in the line of duty, the officer would be entitled to workers’ compensation benefits. Specifically, he or she would be entitled to weekly income benefits should he or she miss time from work as well as medical treatment relating to the injuries sustained in the accident. Furthermore, in the event the injured officer may need mental health counseling for depression or post-traumatic stress, the psychiatric or psychological sessions would also be covered, provided that the officer also had physical injuries.

The state workers or employees can receive up to 400 weeks of income benefits under the law in certain circumstances. Also, the state worker would be eligible for life-time medical treatment for the injuries he or she sustained while on the job. However, the authorized treating physician must document the continued treatment was causally related to the workers’ compensation injury. Lastly, the state employee may be entitled to compensation for any permanent loss of use or impairment. The value of the permanent impairment depends on the severity of the injury, the physician’s evaluation of the loss of use, and the state worker’s compensation rate as determined by the workers’ compensation law.

If you have any questions about state workers’ rights under the Workers’ Compensation Act in Georgia, contact Bryan Ramos at the Ramos Law Firm.

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How Will I Receive Medical Treatment if My Workers’ Comp Claim is Controverted?

Adriana Sola Capifali — Thu, 25 Jun 2009 14:27:24 +0000

When the Employer/Insurer “controverts” or determines a workers’ compensation claim is not compensable, the Employer/Insurer will not pay for the injured Employee’s medical treatment. Consequently, the injured Employee will be responsible for finding a physician to treat with and for payment of his or her medical bills. This determination does not necessarily mean the injured workers’ claim has ended. It is merely the position the Employer/Insurer has taken. It will be the claimant’s burden to prove that the Employer/Insurer is wrong. From a practical perspective, the Employee has the daunting task of locating a qualified physician to continue treatment.

When a claim is controverted, the Employee may choose to treat with a physician of his or her choice, pursuant to Board Rule 201(b). This Board Rule states that “the Employer/Insurer cannot restrict treatment of the Employee to the panel of physicians, conformed panel of physicians, or WC/MCO when the claim has been controverted.” Therefore, the Employee is free to choose his or her authorized treating physician.

Although an injured Employee has greater control of his or her medical treatment when a claim is controverted, the Employee is still left with the challenge of paying for medical treatment. Since the cost for medical treatment will escalate within a short period of time, an Employee must consider alternatives to paying for medical treatment either out of pocket or through another insurance carrier. An attractive alternative for Employees is to identify a physician who will provide medical treatment on a ”lien basis”. Treating on a lien basis means the Employee will not pay for medical treatment or services at the time the treatment is rendered, but will pay for the treatment at the time his or her claim settles.

A physician or medical facility which offers medical treatment on a lien basis to workers’ compensation patients will protect their interests by requiring that the Employee and his or her attorney sign a ”letter of protection.” A letter of protection is a contract between the patient, attorney and medical provider, which ensures the attorney will pay all medical bills for treatment rendered on a lien basis from the Employee’s settlement funds.

Seeking treatment on a lien basis is not the ideal for most Employees and attorneys, but it is a workable alternative for the injured Employee who cannot afford the immediate out-of-pocket cost.

If your workers’ compensation claim is controverted, please contact the Ramos Law Firm to discuss seeking treatment for your work injuries.

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What Role Does Medical History Play in Workers’ Compensation Claims?

Adriana Sola Capifali — Wed, 24 Jun 2009 14:07:57 +0000

Most individuals enjoy a certain level of privacy regarding their medical history. Most employees are weary about sharing intimate details about their medical history with the employer/insurer; however, pursuant to O.C.G.A. 34-9-207, the employer/insurer may be entitled to this information.

In a Georgia workers’ compensation claim, an employee’s personal health information can be used by the employer/insurer to assess the compensability of a claim. Medical records are of interest to the employer/insurer because these records reveal whether an injured worker has previous injuries to the body part injured in the work accident at issue or pre-existing conditions (such as diabetes or high blood pressure). It is critical to investigate previous injuries because the employer/insurer may not be liable for payment of medical treatment for an injury which occurred before the accident at issue and/or did not occur in the course and scope of the employee’s employment. Additionally, if an injured worker is a diabetic or suffers from high blood pressure, these pre-existing conditions can slow down an injured worker’s recuperation or cause complications in healing.

For example, if an injured worker sustains a broken ankle and is also suffering from type 2 diabetes, but is non-compliant with her diabetes treatment plan, he or she may experience delays in her recuperation due to poor circulation or possible nerve damage in the lower extremities. In the aforementioned example, the repercussion of non-compliance with her diabetes treatment plan can lead to serious complications, which may prevent the employee from returning to work and may sever the employer/insurer’s liability for continued medical treatment for the broken ankle. The employer/insurer will point to this fact to deny future benefits. Obviously, this will be a medical question for the administrative law judge.

The medical records are also a tool the employer/insurer can utilize to gather information about injured worker’s conversations with his or her medical providers. Ordinarily, a patient’s conversation with his or her physician is confidential, however, when an injured worker files a workers’ compensation claim and seeks medical treatment for work-related injuries, the patient-physician conversations are no longer considered confidential.

Pursuant to O.C.G.A § 34-9-207, when an employee files a workers’ compensation claim, the employee waives

“…any privilege or confidentiality concerning any communications related to the claim or history or treatment of injury arising from the incident that the employee has had with any physician… .”

Employees should not be discouraged from filing a claim due to privacy concerns. The release of workers’ compensation information to non-parties is generally prohibited under the workers’ compensation code. Employees must keep in mind that in order to receive the best medical care, the doctors must have access to his or her medical history to create an effective treatment plan. The mutual goal of all parties is to return the injured worker back to normal duty if possible. However, it is important to realize that this may never happen depending on the severity of the injury. If the goal of “normal duty work status” is not reachable, then the injured worker should still strive to reach maximum medical improvement.

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Referrals From The Authorized Treating Physician

James Timmons, Jr. — Tue, 02 Jun 2009 14:02:13 +0000

With any injury or illness, it is common for a primary treating physician to find it necessary to refer the patient to another doctor for specialized care. Obviously, in a workers’ compensation setting, this is also possible. The question then arises, how does the Workers’ Compensation Act provide for such referrals?

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

Julia Lindsey — Thu, 14 May 2009 20:47:12 +0000

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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Does the Panel of Physicians Affect the Type of Medical Treatment I Will Receive?

Adriana Sola Capifali — Tue, 05 May 2009 13:36:58 +0000

Employers who are subject to the Georgia Workers’ Compensation Act are required to post a panel of physicians. The employer’s panel of physicians consists of medical facilities or individual physicians who are authorized to render treatment to employees injured on the job. There are three types of panels employers may elect to post:

a Traditional Panel of Physicians;
a Conformed Panel of Physicians; or
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:

internists,
family practice,
orthopedic surgeons,
neurologists,
general surgeons,
chiropractors,
physical and occupational therapists,
psychologists or psychiatrists,
diagnostic pathology or laboratory services,
radiology services and hospital,
outpatient surgery, and
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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Ramos Law Firm Workers' Comp Blog » medical exam

Georgia’s Injured Employees and Workers’ Compensation

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Georgia Workers’ Compensation Changes in 2009

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Required “Notice” under Rule 201(b)

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My doctor considers my injuries disabling, another doctor does not, who has the final say?

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State Employees are eligible for workers’ compensation benefits

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How Will I Receive Medical Treatment if My Workers’ Comp Claim is Controverted?

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What Role Does Medical History Play in Workers’ Compensation Claims?

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Referrals From The Authorized Treating Physician

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

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Does the Panel of Physicians Affect the Type of Medical Treatment I Will Receive?

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