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Changing doctors in the workers’ compensation claim

If the injured worker desires to change physicians within the posted panel of physicians, he or she may do so without approval from the Board or the insurance company.  This change is only allowed one time, however. If the injured employee wants to change physicians to someone not listed on the panel of physicians, he or she must either find a doctor the insurance company will agree to, or formally request the change from State Board of Workers’ Compensation.  See, O.C.G.A. 34-9-201(e).  This holds true if the insurance company wants to transfer care from the established treating physician to another physician.  For example, if the insurance company desires to transfer care away from Dr. Erik Bendiks to Dr. Hal Silcox, it must either convince the injured worker to agree to the change or present evidence to the State Board justifying the change.  This change has tremendous impact on the claim and should not be taken lightly.

If the claim is accepted by workers’ comp and the injured employee treats with an unauthorized doctor, the cost of that treatment will not be covered by the workers’ compensation insurance carrier.  However, the presiding judge may rely upon the unauthorized physician’s reports to find that the employee may be disabled or entitled to benefits.  Georgia Baptist Medical Center v. Moore, 219 App. 171 (1995).   Conversely, the judge may also rely on the unauthorized doctor’s reports to deny the claim.

If the injured worker’s claim is denied or “controverted”, the injured employee can seek treatment with whomever he chooses.  Board Rule 201(b).  However, this treatment will not be paid for by the insurance company unless the State Board orders payment or the insurance company voluntarily pays.  Generally, this issue will come before the State Board and the claimant will bear the burden of demonstrating that the injury arose out of and in the course of his or her employment.  If the injured employee is successful, the costs for the treatment incurred will likely be covered by the presiding judge’s award.

Settlement in Workers’ Compensation Claims

The term “settlement” can be very confusing in the Georgia workers’ compensation field.  Essentially, a “settlement” is an agreement between the parties where one party receives financial compensation in exchange for releasing the other party from any further obligations or threat of prosecution.  Additionally, a settlement will likely incorporate a formal separation of employment.  At the Ramos Law Firm, we believe that “timing” is very important when considering whether an injured worker should entertain the settlement of his or her case.  We believe that settlement cannot be forced or rushed in an accepted workers’ compensation claim as the injured employee must consider his or her health first.  Generally, our firm believes that the insurance company should be held to provide the injured worker with quality medical care until the condition improves.  However, every case is different.

The value of the settlement depends on many factors.  Some likely factors affecting the settlement value of any case include the severity of the injury; the authorized treating physician’s opinion as to disability and future medical treatment; the injured worker’s average weekly wages; and the ability of the Employer to return the injured work back to work.  Again, no two cases are exactly the same and the value of the potential settlement is very fact sensitive.  It is important to note that the State Board does not have authority to mandate a settlement in any case.  The parties must mutually agree to settle the case.  In other words, the Court cannot order the insurance company or the injured worker to enter into a settlement agreement.

Obviously, the determination of whether to settle the case and for how much deserves a thorough analysis of the medical records, wages, and applicable facts of the case.  Contact the Ramos Law Firm for a free consultation.

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Reporting a Work Accident and Injury

When an accident happens at work and an injury occurs, the first thing an injured worker should do is seek medical attention by reporting the event to the immediate supervisor or manager.  The injured employee should report the details of the accident but focus on securing medical attention.  At our firm, we encourage (more…)

Tax reporting for Workers’ Compensation income benefits and settlements

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The State Board of Workers’ Compensation requires notice of temporary partial disability conversion

Effective January 1, 2014, Board Rule 104 requires that Form WC-104 be filed with the Board at the same time (more…)

Changes to the Georgia Workers’ Compensation Law in 2013

Employees injured on or after July 1, 2013 will be operating under a new set of rules. Georgia House Bill 154 was signed into law by Governor Nathan Deal. The new law limits medical treatment for (more…)

Injured while working at Coca-Cola in Atlanta, Georgia?

The Coca-Cola Company is an American icon in our culture.  However, sometimes its workers are injured while on the job.  Over the past years, the Ramos Law Firm has represented employees working in Atlanta and other cities around the state of Georgia.  In representing these injured workers, we have compiled a short list of things to do if you are hurt on the job:

  1. Report it to your supervisor. (more…)

Georgia’s New “Limited Medical” Law Shifts Costs to Medicare

The Georgia Governor and Legislature amended the Workers’ Compensation Act to limit the medical benefits afforded to injured workers.  Currently, if you are injured on the job, you are entitled to (more…)

New Workers’ Compensation Bill before the 2013 Georgia House of Representatives

The 20113 Georgia Legislature is considering amending the Workers’ Compensation Act. 

With regards to medical treatment, the proposed bill takes aim at limiting coverage to the injured workers.  Currently, if you are injured on the job, you are entitled to (more…)