Unfortunately, this is a common problem.  The workers’ compensation law provides that this injured Thomaston worker is entitled to medical treatment at the Employer/Insurer’s expense.  Moreover, the hurt employee is not limited only to treatment at Upson Regional Medical Center.  If the treatment for the back injury requires specialized treatment, the Employer/Insurer would be responsible for that treatment as well.

In addition, if the employee could not return to work because of his work injury, or even was fired because of his work injury, then the Employer/Insurer would be responsible to pay for the employee’s weekly income benefits.  Unfortunately, these benefits are limited by the “workers’ comp rate” and the injured worker’s “average weekly wage.”  This determination is made on a case by case basis.

If you have been injured on the job and you would like a free consultation, please contact the Ramos Law Firm at (404) 355-3431.

Georgia’s Workers’ Compensation Act provides compensation in relation to the physician’s impairment assessment.  This table is found in O.C.G.A. §34-9-263 or on our website.  In certain circumstances, doctors may disagree as to the ratings and they can differ.  Also, you may have the option of seeking a second opinion.  If you have any questions about the PPD rating, please contact me at 404-355-3431.

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.

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.

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.

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.

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.

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.

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.