How do you know which doctor to go to after you get hurt at work? Most people do not know their rights.
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” and then they send you there for treatment.
If your employer tells you this or something similar, are they right? Also, how much does it matter which doctor treats your injury?
Let me answer the second question first. It will probably matter a lot which doctor provides treatment for you.
Why is that? Your doctors have a lot of power in your workers compensation case. They decide what medical treatment you need. They also have influence over whether you can return to work and what sort of work you can do.
You want to make sure you go to a good doctor. That brings me back to the first question above.
Can the workers compensation insurance company 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 that provide treatment for your injury (often known as the authorized treating physician or an authorized treating physician)
- Doctor that perform an examination/evaluation but do not perform treatment (often known as IME doctors)
Different rules apply to these two different roles. First, I am 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
Good news. Neither your employer nor their insurance company can force you to go to a specific doctor for treatment of your injury. You have some choice about which doctor you see.
Your employer should have posted what is called a panel of physicians. This is a list of doctors who can provide treatment for your injury.
If you get hurt on the job, you can pick one of those doctors off the list to provide you with treatment. You also have a right to change to a different doctor on the panel if you want.
This article I wrote has a detailed discussion of your rights to pick a doctor off the panel of physicians. Be sure you understand those or have an attorney on your side who does because doctors are 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, or Independent Medical Evaluation.
An IME is not for treatment. It is an evaluation/examination. The doctor should not perform any treatment on you at the IME. They should just examine you and prepare a report.
The insurance company uses a part of Georgia’s workers compensation law called O.C.G.A. 34-9-202. That part of the law allows the insurance company to pick a doctor and have you evaluated by that doctor.
Often, the insurance company will tell you they are scheduling you a second opinion. The insurance company usually uses these evaluations to try to avoid paying benefits to you. They hope that the IME doctor will say that you do not need medical treatment or that you can go back to work.
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 rules to schedule the examination. This article I wrote provides a more detailed discussion of O.C.G.A. 34-9-202 evaluations and the rules that apply.
One common mistake many people make is continuing to treat with the IME doctor after the 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.
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 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 compensation 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 benefits suspended.
What if I have other questions about Georgia’s workers compensation rules regarding medical treatment?
We have articles on our blog that address all different areas of Georgia’s workers compensation law. You can find the articles discussing medical treatment on the Medical Treatment Rights page.