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Examinations by Insurance Company Doctors4 minute read

You might have received a phone call from the insurance company or a company hired by the insurance company saying you have an appointment with a doctor you don’t know.  The person calling may have told you it was for a second opinion or an independent medical evaluation (IME).  You might have just received a letter notifying you that an appointment had been scheduled with a different doctor.  You probably have lots of questions about this appointment such as:.

  • Do you have to go to the appointment?
  • Do you have any say in which doctor the insurance chooses?
  • Will the doctor be fair?
  • Can you do anything if you do not like the doctor?

This article will attempt to help you understand what this medical examination is and what it means.  The first important thing to understand is that this article is only discussing medical examinations where the insurance company decides on their own to get you an evaluation.

The rules are different when your doctor refers you for treatment with a different doctor.  If you have been referred by your workers’ compensation authorized treating physician for treatment, then you should read our article discussing medical treatment after your work injury.

What limits are there on the insurance company’s rights to a second opinion?

Georgia workers’ compensation law does allow the insurance company to schedule evaluations for you with a doctor that they choose.  The part of the law that allows them to schedule these evaluations is O.C.G.A. 34-9-202.  The idea is that the insurance company should be able to get a “second opinion” about your medical treatment, as long as they agree to pay for it.  However, the insurance company’s right to a second opinion does have limits.

  1. The appointment is just an examination; it is not treatment – the insurance company can pick the doctor to conduct the examination, but they cannot force you to change to this doctor for treatment (although they may try to use the report from the examination to get a judge to change your doctor)
  2. The insurance company has to prepay your mileage costs to the examination – the letter scheduling the examination should include a check paying you in advance for the costs of the mileage.  The law requires this.  Usually, you only get paid for mileage costs after the treatment has occurred, but this is different.
  3.  The examination must be at a reasonable time and place – in other words, there are limits on how far the insurance company can make you travel.  If there is a dispute about this, it will usually be decided by a workers’ compensation judge
  4. You can have another doctor attend the appointment with you, but you have to pay him or her – this right is not used much because it could be very expensive to hire a doctor to attend an appointment with you.

Many people are concerned about whether the doctor picked by the insurance company is going to conduct a fair and accurate examination.  Our firm has certainly seem many reports from medical examinations scheduled by insurance companies that we did not believe were fair and accurate reports.  If the medical report is not fair, it could hurt your case.  As a result, you might not end up receiving the medical treatment you need.

What can I do if the insurance company doctor is not fair?

A good attorney specializing in Georgia workers’ compensation cases can usually help prevent this from happening.  Even if you get a bad report from the doctor the insurance company picks, the attorney can help you arrange your own examination with a good doctor to get another opinion about your injuries.

If the insurance company denies the medical treatment you need based on a report from the doctor the insurance company picked, an attorney can request a hearing to get the medical treatment you need approved.  If you would like to find out more about what is involved in hiring an attorney on your case, just click here to read one of our articles that will provide you some more helpful information.

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, I would recommend that you try to get answers.  To find out more about how to schedule a time to talk to me about your workers compensation questions, just read this short article.

Jason Perkins is an attorney who specializes in representing injured workers.  He regularly publishes videos and write blog articles about Georgia’s workers compensation system and issues that are important to injured workers and their families.

To be notified of Jason’s new workers compensation videos, subscribe to his Georgia Workers Compensation Video Series channel on YouTube by clicking the subscribe button below.

Brittney-lee orourkeBrittney-lee orourke
05:23 18 Feb 22
Amazing! Jason and his team were very helpful and had the best communication by far. Walked me though every step with great detail and had answers for any question I had. They handled my case better then I could imagine, it was a weird case and they stayed on top of it and kept me updated every step of the way! Highly recommend this Team! Thanks so much to Jason and his Awesome team!-Brittney
China JonesChina Jones
18:58 08 Feb 22
I absolutely love this group of attorneys, when I was at my lowest they did everything they could to help me get justice for my injury. I believe if I were to have never picked my phone up and called the amazing group that helped me I definitely would not have received my idea of rights. If you have an issue and are just not sure please understand that they will help you, stay in contact, answer any question you have, and for sure get you the justice you deserve I thank them from the bottom of my heart and I will definitely refer them to anyone who has been hurt because they most definitely care about their work and clients.
Luv LocsLuv Locs
16:08 15 Jan 22
The entire law office was attentive and responsive to all of my concerns dealing with my workers compensation case.
moombimoombi
21:14 02 Jan 22
If you must get a lawyer involved, you’d do well to work with Jason Perkins and his team at Perkins Studdard Law.They were thorough in gathering information and in sharing all the steps in the workers comp process specific to my case. Jason and the team were responsive to my bevy of questions and concerns.I appreciated the informative videos and consultations provided by Jason over video meetings and multiple phone calls.I hope I’m never injured on the job again. However, if I am and if my employer responds as my previous employer did, I’ll contact Perkins Studdard Law immediately to handle the case.
Dana BessDana Bess
23:57 10 Dec 21
Everyone at Perkins Studdard was kind and professional. They were always extremely responsive and answered all questions that I had and followed up to make sure I had an understanding of what was going on along with emailing videos to explain every step of my case so I would know what to expect and be prepared. Jason is a very genuine person and I trusted him with my case. He answered so many questions for me even before I retained him as my WC lawyer. I highly recommend him and his associates at Perkins Studdard.
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