How do you know which doctor to go to after an on-the-job accident? Most people have no idea which doctor to pick. They also do not know whether they have any input in selecting a doctor to treat their injury.
This happens because most people have not had any experience with workers’ compensation. Here is what often happens after somebody gets injured at work:
- They report the injury to their employer.
- Their employer tells them, “You’ve got to go down to the urgent care clinic or the occupational doctor. This is the doctor that we use for injuries.”
- Your employer sends you there for emergency treatment and you are treated by that doctor because that is what they told you to do.
If your employer tells you this or something similar, are they right? Also, does it really matter which doctor treats your injury?
Let’s answer the second question first. It will almost certainly matter a lot which doctor provides actual treatment for you.
Why is that? First of all, you want to get better. If you see a bad doctor, you will probably not get better.
Another equally important reason that your doctor matters is that doctors have a lot of power in your workers’ compensation case:
- Your workers compensation doctors decide what medical treatment you need.
- They also influence whether you can return to work and what sort of work you can do.
- Their medical records often determine whether you will really get the recommended treatment for your on-the-job injuries.
Because of all this, you want to make sure you are treated by a great doctor. So, let’s talk about that first question above – is your employer right when they tell you that you have to go to their doctor?
Can The Workers’ Compensation Insurance Carrier Force You To Go To Their Doctor?
The answer to this question is “Sometimes, but not most of the time.” That answer is confusing, but you can understand it better if you understand the different roles that doctors have in a workers’ compensation case.
There are two basic roles for doctors in workers’ compensation cases:
- Doctors who provide treatment for your injury (often known as the authorized treating physician or an authorized treating physician)
- A doctor who performs an examination/evaluation but does not perform the treatment (often known as an IME doctor)
Different rules apply to these two different roles that doctors have in workers’ compensation cases. First, we are going to discuss some of the rules that apply to treating doctors and whether the insurance company can force you to go to a specific doctor for treatment.
The Insurance Company Does Not Have The Power To Pick Your Workers’ Compensation Treating Doctor
If you’ve been injured on the job, you might wonder: can your employer or their insurance company dictate which doctor you see? The answer is no. In Georgia, injured workers have rights when it comes to choosing the doctor who treats their workplace injury. Understanding these rights is key to ensuring you get the care you need.
Your Employer’s Panel of Physicians
Georgia workers’ compensation laws require employers to provide a Panel of Physicians, which is essentially a list of doctors that have been approved. This panel must:
- Include at least six doctors from various specialties.
- Be posted in a visible location at your workplace.
If you get hurt on the job, the first step is choosing one of these doctors from the list. The doctor you select becomes your authorized treating physician (ATP).
Why Your Choice of Doctor Matters
The doctor you choose plays a significant role in your recovery. They will:
- Provide treatment for your injury.
- Order necessary tests, such as X-rays or MRIs.
- Refer you to specialists if additional care is required.
The quality of your care depends on the doctor you select. A knowledgeable and attentive physician can ensure you receive timely treatment and improve your chances of a full recovery.
What If You’re Not Happy with Your First Choice?
Sometimes injured workers feel pressured to make a quick decision about which doctor to choose. Maybe your employer suggested a specific name, or you picked someone without enough information because you needed to get treatment quickly. Don’t worry: Georgia law gives you the right to change doctors on the panel of physicians.
Here’s how it works:
- You can switch to another doctor on the panel without needing your employer’s approval.
- This gives you a second chance to find a doctor who better meets your needs.
This option is particularly helpful if your initial doctor isn’t providing the level of care you expect. Switching can ensure you get the treatment necessary for a faster recovery. But, be aware that your free change on the panel of physicians can only be used once. So, you need to make sure you make the proper decision if you decide to change doctors.
Why Treating with the Right Doctor Makes a Difference
Your authorized treating physician can influence every aspect of your workers’ compensation case:
- Quality of Treatment: A skilled doctor will diagnose your injury accurately after a workplace accident and develop an effective treatment plan.
- Timely Care: Faster treatment can lead to better outcomes and help you return to work sooner.
- Documentation: Your doctor’s records and reports are critical for supporting your workers’ compensation claim. Poor or incomplete documentation can lead to challenges with your benefits.
Choosing a great doctor helps ensure that your recovery – and your claim – are in good hands.
This article written by Attorney Jason Perkins has a detailed discussion of your rights to pick a doctor off the panel of physicians. Be sure you understand those or have a workers’ compensation lawyer on your side who does because treating with a great doctor is extremely important to recovering from your injury.
When Can The Insurance Company Force Me To Go To A Specific Doctor?
Now, there are some situations where the insurance company can force you to go to the doctor they pick. The most common situation is what’s called an IME. IME is an abbreviation for Independent Medical Evaluation.
An IME is not for treatment. It is just an evaluation. The doctor should not perform any treatment on you at the IME. They should just examine you and prepare a report based on their examination and review of your medical records.
The insurance company uses a part of Georgia’s workers’ comp law called O.C.G.A. 34-9-202 to schedule IMEs. That part of the law allows the insurance company to pick the doctor they will use for the IME and have you evaluated by that doctor.
Often, the insurance company will tell you they are scheduling you a second opinion. They then send you an email, letter, or text with details about a medical appointment with a different doctor.
The insurance company does have the right under the law to schedule those examinations and to force you to attend them. However, they have to follow certain very specific rules to schedule the examination. This article written by Attorney Perkins provides a more detailed discussion of IME evaluations and the rules that apply.
One common mistake many people make is continuing to treat with the IME doctor after the IME appointment. The insurance company has a right to schedule the IME with the doctor they pick, but they do not have a right to just change you to that IME doctor for ongoing treatment.
Any ongoing treatment would have to be with your agreement to change doctors or a workers’ compensation judge ordering a change of doctors. But if you just start going to the doctor the insurance company wants you to see, they will probably let you continue doing that because they have now gotten you to the doctor they want you to use. You can avoid this by not following up with the IME doctor for actual treatment but instead continuing to treat with your authorized treating physician.
Why does the insurance company schedule an IME?
If the insurance company has scheduled you for an Independent Medical Exam (IME), it’s important to approach the situation carefully. These exams may seem routine, but their purpose often isn’t to help you: it’s to help the insurance company save money.
Why Insurance Companies Use IMEs
Insurance companies are businesses, and their primary goal is to minimize costs. IMEs are one of their tools to cut expenses in your workers’ compensation case. Here are the most common reasons they schedule these exams:
- To Challenge Expensive Treatments: If your authorized treating physician recommends expensive procedures, like surgery or advanced therapies, the insurance company might schedule an IME to get a second opinion. They hope the IME doctor will disagree with your treating physician, giving them a reason to deny paying for these treatments.
- To Reduce or Stop Wage Loss Benefits: When you’re receiving wage loss benefits, the insurance company may use an IME to argue that you’re ready to return to work. If the IME doctor says you’re capable of performing any type of job (even light duty) the insurance company could use that opinion to try to stop or reduce your benefits.
- To Save Money on Your Case: IMEs are expensive, and insurance companies don’t schedule them without a reason. If they’re spending money to send you to another doctor, it’s because they believe the results will help them reduce the overall cost of your claim.
What to Expect from an IME
During an IME, the healthcare provider will evaluate your condition but won’t provide treatment. The exam may include:
- Reviewing your medical history and treatment records.
- Asking questions about your symptoms and recovery.
- Performing a physical examination.
The IME doctor’s findings will be submitted to the insurance company in a report. While some doctors provide fair evaluations, others may lean in favor of the insurance company, especially if they regularly perform IMEs for them.
Why You Should Be Cautious
The IME doctor’s report can significantly impact your workers’ compensation case. Insurance companies often use these reports to:
- Deny or delay necessary treatments.
- Reduce your disability rating.
- Argue that your job-related injuries aren’t as severe as claimed.
- Justify cutting off wage loss benefits.
- Claim that you are faking, exaggerating your injury, or malingering
- Try to change your workers’ compensation doctor
Because of this, it’s critical to approach an IME with caution and preparation. To protect yourself, it is often best to talk with a workers compensation attorney prior to the IME appointment so you can make sure you are as prepared as possible.
Can the insurance company ever force me to treat with a specific doctor?
Not usually. The one situation where the insurance company can force you to treat with a specific doctor is when they succeed in getting your doctor changed. This generally happens after a hearing or as a result of a request to change physicians.
A judge at the Georgia State Board of Workers Compensation can say that a particular doctor is the authorized treating physician in your workers’ compensation case. In certain situations, you can lose your right to workers’ comp benefits if you do not treat with your authorized treating physician. So the insurance company can potentially force you to treat with this doctor or have you risk having your workers’ compensation benefits suspended.
Do I Have a Right To See The Workers’ Comp Doctor I Want?
Yes, to an extent. Your rights to treat with the doctor you want are dependent on whether your employer followed the rules. If your employer properly posted and explained the panel of physicians, your rights will be fairly limited. If your employer did not follow these rules, you will often be able to choose any doctor you want for treatment.
You also have rights to get a second opinion or an IME paid by the insurance company in certain situations. There are limits on these rights, but they can be helpful in getting you evaluated by a great doctor. Also, the reports from these second opinion or IME evaluations can often be used to get your doctor changed so that you can get the treatment you need.
What If I Have Other Questions About Workers’ Compensation?
Georgia’s workers’ compensation system can be very confusing. You have to worry about getting the treatment you need and paying your bills while also worrying about not missing any deadlines that could cause you to lose your right to receive workers’ compensation benefits.
If you have questions about your treatment options, we would recommend that you try to get answers. To find out more about how to schedule a time to talk to an experienced workers’ comp lawyer about your questions, just read this short article.
