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.

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.

Orthopaedics is a branch of medicine that addresses the prevention or correction of injuries or disorders of the skeletal system and associated muscles, joints, and ligaments. As many work injuries involve broken bones, herniated spinal discs, and joint trauma, these physicians are essentially “bone and muscle doctors.”

Also, orthopaedists may specialize in the treatment of certain bones or joint systems. For example, some orthopaedists will exclusively focus on particular body parts such as shoulders, knees, hands, elbows, or the spine. These physicians are experts on the systemic workings of those body parts who can resolve disputed causation issues or compile future treatment or rehabilitation plans.

Orthopaedics may also develop their practice into orthopaedic surgery. While this is often in areas of sports medicine, the physicians perform the surgical repairs necessitated by common accidents as well. These surgeons will also be instrumental in developing and monitoring the patient’s coordination of physical therapy and other modalities of recovery. An orthopaedic surgeon also addresses the interplay of pathology found in the patient’s central or peripheral nervous systems that affect his or her musculoskeletal components. However, if the patient’s pathology strays too far away from the bone or muscle arena, the orthopaedic surgeon will likely consult with another specialist.