Ramos Law Firm Workers' Comp Blog » physicians

How often can I see the workers’ compensation doctor?

Bryan Ramos — Sun, 13 Sep 2009 03:43:08 +0000

When an injury on the job occurs, the Employer and their insurance carrier are responsible for furnishing medical treatment to the hurt employee. However, the Employer and insurance carrier will generally have a pre-approved list of doctors for the injured work to choose from. Once the injured worker makes his or her selection, the number of visits is unlimited as long as the occupational injury exists. Obviously, the treating doctor will set the care plan. However, as long as the work injury necessitates treatment, the injured employee is entitled to receive the medical care.

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.

Understanding Your Georgia Workers’ Compensation Claim

Bryan Ramos — Wed, 02 Sep 2009 15:42:11 +0000

When an employee files a workers’ compensation claim in Georgia, the process may become confusing, frustrating, and costly. Generally, the injured worker wants immediate medical care and income benefits because he or she got hurt on the job. The insurance company, on the other hand, wants to delay and investigate the matter to save as much money as possible. These opposing forces often cause a lot of heartache and anger.

After the workers’ compensation claim is filed, everyone begins speaking a different language. The insurance company and their lawyers use acronyms such as TTD, PPD, or MMI. The doctors will often throw terms around like MRI, CT, PT, or FCE. The judge may even mandate you to treat with something called an “orthopod”. Being on “workers’ compensation” is not easy and the injured employee did not ask to be hurt.

An injured worker should not go at it alone. The insurance companies have complex programs and systems designed to maximize the law to their benefit. Also, many insurance companies hire skilled lawyers who devote their entire lives to protecting these corporations. It is the classic “David v. Goliath” situation.

Who is protecting the injured worker? At the Ramos Law Firm, our attorneys can level the playing field for you. Our lawyers use their knowledge of the insurance defense practice to help workers hurt on the job. We have extensive trial experience, and we are ready to put it to work for you. For a free consultation, please contact us.

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.

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.

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.

The term “physician” has a broad definition in Workers’ Comp

Julia Lindsey — Tue, 17 Mar 2009 05:03:25 +0000

In a recent ruling by the Appellate Division, a neuropsychologist is a “physician” defined by O.C.G.A. § 34-9-201(a). Pursuant to O.C.G.A. § 34-9-201(a), the term “physician” shall include any person licensed to practice a healing art and any remedial treatment and care in the State of Georgia. Providing that a treating neuropsychologist meets the definition of a “physician” under O.C.G.A. § 34-9-201, an administrative law judge may find and conclude that a neuropsychologist’s medical opinion is properly admissible to support a finding that an employee sustained a particular PPD rating.

Recent Court of Appeals Decision – Change of Condition

James Timmons, Jr. — Thu, 05 Feb 2009 05:40:10 +0000

The Georgia Court of Appeals made an interesting decision on July 10, 2008 in United Grocery Outlet v. Bennett, 292 Ga.App. 363 (2008). In essence, the decision states that the formal notice requirements of O.C.G.A 34-9-221(c) has no effect on the statue of limitations imposed by O.C.G.A. 34-9-104(b).

The facts in Bennett are essentially that the claimant’s income benefits were terminated in November 2001. No form WC-2 was filed as is required by statute. In December 2003, the employer terminated the claimant’s employment. The claimant filed a hearing request in October 2004 seeking a change in economic condition.

The claimant relied heavily on Russell Morgan Landscape Management v. Velez-Ochoa, 252 Ga. App. 549 (2001) as standing for the proposition that since the form WC-2 was never filed to give the claimant notice of the suspension of her benefits, then the statute of limitations should have been tolled.

The Court of Appeals disregarded the Ochoa argument, holding that the plain language of O.C.G.A. 34-9-104(b) does not provide for the tolling of the statute of limitations based upon the failure to properly notice the suspension of benefits. Rather it only provides that any claim for change of condition must be brought within two years of the last payment of benefits under O.C.G.A. 34-9-261 or 34-9-262. The Court expanded upon this notion by adding that because the claimant was aware of the fact that she was no longer receiving benefits, there was no due process issue as to notice.

This case should put us all on notice to pay attention to the last date that income benefits are received, without regard to whether the statutorily prescribed procedure has been followed, in order to avoid having claims time-barred.

What medical benefits must a company provide to be compliant with Georgia Workers’ Compensation Law?

Bryan Ramos — Fri, 08 Feb 2008 22:30:00 +0000

Georgia law 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. Georgia law requires that one of the six physicians must be an orthopedic surgeon who specializes with hand and upper extremity injures; and no more than two (2) professional associations or corporations of physicians can be industrial clinics.

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.