In Georgia, the insurance company is responsible for providing injured workers with medical benefits such as trips to the emergency room, hospital stays, prescription medication, mileage, and visits with the doctor.  If the injured worker is unable to return back to work because of his or her work injury, then the injured employee may receive weekly income benefits up to $500 per week.   These weekly benefits will expire after some time or until the physician releases you to “full duty” work status.

If you have been injured on the job, please contact the Ramos Law Firm for a free consultation.

In addition, medical benefits may include counseling, or may include home attendant care, and in some circumstances domestic household services.  These benefits may also include newly developed medical procedures under FDA investigation despite the fact that the procedures have not yet been approved by the FDA.

In many instances, employees hurt at work experience delays in authorization, mysterious or last minute request for second opinions, or flat denials of their medical treatment.  As medical treatment is crucial, it is important to have someone advocating for you.  Not only must this advocate have expertise about the law, but he must be knowledgeable about the physicians treating the injured worker.

If you have been hurt at work and would like a free consultation about your rights to medical care under the Georgia Workers’ Compensation Act, please contact the Ramos Law Firm at 404-355-3431 or via email.

Our firm has experience in handling claims where employees injured themselves inside the terminal, on the tarmac, and even during flight. These injuries involved eye claims, back herniations, carpal tunnel surgery, hearing damage, and knee replacements. Our firm is equipped to handle clients who have worked as airplane mechanics, pilots, ground crews, hangar workers, shuttle bus drivers, ticketing clerks, and food service employees such as Atlanta Bread Company workers.

Don’t be left guessing whether or not you are entitled to workers’ compensation benefits, call our firm today for a free consultation 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.

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.

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.

As discussed at length in a previous blog, the employer has a duty to maintain a list of at least six physicians.  There are guidelines as to the makeup of the panel as well. The employer is then required to take reasonable measures to make sure that the employees understand their rights in terms of selecting a panel physician.  Failure to do so will result in the employee having the right to treat with any physician of her choosing.

In the case decided by the Appellate Division, an employer did not advise an injured employee of her right to choose her own physician from the panel until four days after the accident.  Prior to the accident, the employee had never been shown the panel, nor had it explained to her that she had the right to choose any doctor from the panel in the event of a work injury. The Appellate Division therefore held that based upon the omissions of the employer, the employee was entitled to choose any physician to treat her at the employer’s expense.

This decision reinforces the fact that employees should take the time to be aware of their rights.  Conversely, employers should take the time to properly inform their employees about their rights under O.C.G.A. 34-9-201 to protect themselves from additional exposure.

Employer may maintain a traditional panel of physicians that shall consist of at least six (6) non-associated physicians. Employers are allowed to have more than six physicians on this panel as well. The minimum panel shall include an orthopedic physician, and no more than two physicians shall be from industrial clinics. This panel shall include a minority physician, where feasible.

Employers may maintain a list of physicians that shall be known as the conformed panel of physicians, which shall include a minimum of 10 physicians or professional associations. The physicians and groups listed on the panel shall be counted as a separate choice from the others listed only if they are not associated with other physicians or groups on the panel. This panel includes the same physicians required in the traditional panel, plus a chiropractor and a general surgeon.

Finally, Employers may contract with a Workers’ Compensation Managed Care Organization (WCMCO) certified by the Board. A “WCMCO” provides for the delivery and management of treatment to injured employees with a complex network of physicians. The WCMCO sets its own rules and regulations for treating the Employees.

As a matter of course, Employers must post the panel in prominent places around the work area or in the case of a WCMCO, provide a toll-free number to every Employee where she can facilitate treatment. Moreover, Employers must fully explain the purpose of the panel to all Employees and must assist Employees in obtaining medical care when an injury occurs.

An Employee may select any physician on the panel and may make one change to another physician on the panel without approval of the Employer. Further changes require approval of the Board or by agreement of the parties.

The Board further stresses that if the company is located in an area where it is feasible, minority physicians should be included as an option. This being said, there are options for the injured employee who is not satisfied with his employer’s options.

Under Georgia law an employee may switch physicians for treatment purposes one time without anyone’s permission. This new physician becomes the new authorized treating physician for workers’ compensation purposes. All subsequent medical referrals will generally flow through this new physician to make sure that all medical care is coordinated.

Georgia workers’ compensation law recognizes “life time” treatment for the work related injury. The Employer is responsible for treatment, mileage reimbursement, therapy, and prescription medication as long they have been prescribed the authorized physician as being related to the occupational injury.

For more information, please contact Bryan Ramos.