How To Get The Medical Treatment You Need After A Workers’ Compensation Injury
If you are injured on the job, workers compensation can help you recover but you need to follow a process. One of the most important of these benefits for the purposes of your recovery is payment for the medical treatment you need after a work injury.
What to do after your work injury
To make sure you are able to get medical treatment, the first things you need to do is make sure to report your injury to employer as soon as possible. If you get medical treatment before reporting your injury, the workers’ compensation insurance company will probably not be responsible for paying for that medical treatment.
Prompt notification will enable the insurance company to begin your benefits in a timely manner. Also, in Georgia, if you do not report you injury within 30 days, you may lose all of your workers’ compensation benefits.
After you report your injury
After you report your injury, your employer should present you with choices of doctors where you can get medical treatment. This list of doctors usually is called a panel of physicians.
With workers compensation, who can provide medical treatment?
One of the primary benefits of workers compensation is medical coverage for the treatment of your injury. Usually, your employer provides a limited choice of doctors who can provide treatment for your injury at work. Your employer can provide medical treatment in one of the following ways:
- Panel of Physicians – This must contain at least six qualified physicians. The makeup of the panel must include at least one orthopedic surgeon, a minority physician and four other properly qualified physicians.
- Workers’ Compensation Managed Care Organization (WC/MCO) – A WC/MCO offers a much larger choice of treating physicians from many disciplines. The WC/MCO must be approved by the Georgia State Board of Workers’ Compensation.
Most likely, your employer has selected the first option which is the basic “panel of physicians”. If so, the doctor you select as your authorized treating physician to treat your injury must be from the “panel of physicians”.
Your employer should have posted the panel at your workplace. Most of the time, the panel is located on a bulletin board in the breakroom or near the time clock where your employer keeps other documents, such as minimum wage information, that are required to be posted by law.
If you cannot find the panel, you should ask your employer to show you where it is located and also to provide you with a copy of it. You want to have a copy of the panel in case you need it later.
What does a panel of physicians look like?
An example of a typical panel of physicians is shown below. This list of physicians will be printed on legal sized pink paper. At the top, it should say “OFFICIAL NOTICE. This business operates under the Georgia Workers’ Compensation Law.”
In the bottom half of the document, it should contain the name, specialty, address and phone number of at least six different doctors. At least one of these doctors must be an orthopedic doctor and no more than two should be “industrial clinics”.
If your employer does not have this list of doctors properly posted or if the list of doctors does not seem to meet all the requirements of Georgia workers’ compensation law, you may be able to pick any doctor you want to serve as your main workers’ compensation doctor.
If your employer has complied with all of the requirements and properly posted and explained the panel of physicians, then you must go to a doctor on the list. You do have a right to change doctors one time to a different doctor on the list. Any other changes of doctors after that one time require your employer’s agreement or an order from a judge at the Georgia State Board of Workers’ Compensation.
The details can be confusing. Workers’ compensation is a great way to get you back into the workforce, but there are rules and procedures to follow. Employers and employees each have responsibilities that determine the quality of your care. It is up to you to make sure your workers compensation insurance company provides you with all of the benefits necessary for recovery.
Choosing The Right Doctor
Although your employer gets to determine which doctors are on its workers’ compensation panel of physicians, you get to choose which doctor will treat you for your injury at work. Choosing the right doctor is crucial. The doctor you choose will become your authorized treating physician and will decide the extent of the medical care you need.
In Georgia, your authorized treating physician can refer you to a specialist. That specialist can can provide the care necessary for maximum recovery from your injury. Most importantly, the doctor you choose will play a large factor in determining what benefits workers compensation pays and when you can return to work.
What Medical Treatment does Workers Compensation Cover?
Workers’ Compensation covers one hundred percent of authorized medical treatment for your work injury. You do not have a deductible or co-pay like you do with group health insurance. You do not have to pay for any authorized medical expenses. If you are billed for those costs, contact your employer, workers’ compensation provider, or a workers’ compensation attorney to assist in getting the charges corrected.
In An Emergency
In a true emergency situation, you may get temporary medical care from the nearest emergency location available. Once the emergency is over, you must continue your care by selecting a doctor from the list of physicians provided by your employer.
Prior to scheduling any major surgical procedures for an on-the-job injury, except in the case of an emergency, most doctors will request approval from the workers’ compensation insurance company. Often, you may experience delays in getting the treatment you need while you wait for approval. The insurance company may even deny treatment that your doctor thinks you need. You can fight to get this treatment approved.
MRI, CT Scans, Specialists and Physical Therapy
Georgia workers’ compensation covers anything your authorized treating physician refers you for as long as it is:
- Related to your injury at work, and
- Reasonable and necessary medical treatment.
This includes tests (such as MRIs, x-rays, and CT Scans), evaluations, referrals to specialists, physical therapy, injections, and other procedures.
Georgia workers’ compensation covers prescription drugs. The problem with prescription drugs is that pharmacies may often want approval from the workers’ compensation insurance adjuster.
Pharmacies usually want to get approval before dispensing the medication. If the insurance company does not approve the medication, you may not get the treatment you need. You might also have to pay for the medication and seek to get reimbursed later.
Other medical expenses and reimbursements
The Workers’ Compensation law in Georgia provides for reimbursement of certain expenses necessary to get medical treatment. This includes such things as mileage, meals, lodging and other expenses.
You incur these expenses in order to ensure you receive quality medical care. While mileage is always covered, the insurance company only has to reimburse for meals and lodging when your travel for medical treatment is over a certain length.
Getting another opinion about your medical treatment
One way of getting another opinion about your medical treatment is to use O.C.G.A. 34-9-202. This part of Georgia’s workers compensation law allows you to get a medical evaluation in certain circumstances. An O.C.G.A. 34-9-202 evaluation is often referred to as an IME or “independent medical evaluation”.
When you have received weekly workers’ compensation benefits (either temporary total, temporary partial, or permanent partial disability benefits) within the last 120 days, you have a right to be evaluated by a doctor of your choosing. There are a few important things to understand about this evaluation:
- You can only get the insurance company to pay for one 34-9-202 evaluation in your entire case
- The doctor can only evaluate you, not treat you
- The doctor can order reasonable and necessary testing in the evaluation
A 34-9-202 evaluation can be useful if you do not feel your current treating doctor is helping you get better or you just want another opinion about some recommended medical treatment. However, you can sometimes get another opinion without using your one time O.C.G.A. 34-9-202 evaluation.
If your authorized treating physician refers you for a second opinion, then the insurance company should pay for that referral. The second opinion will be very similar to the 34-9-202 evaluation, but there are a few important differences:
- You must have a referral from your authorized treating physician to get a second opinion evaluation
- Your doctor (not you) generally chooses the doctor for the second opinion
- The insurance company may not have to pay for recommended testing by the second opinion doctor unless your authorized treating physician agrees with the recommendations and sends you for those tests
Paying for the Evaluation Yourself
A final way to get evaluated by another doctor is to just pay yourself. While this gives you the freedom to see any doctor you want, it is obviously difficult to do. Medical treatment is expensive.
If you have the money and want to pay for an evaluation yourself, you can certainly do that. This evaluation might be useful in getting a change of physician or helping you prove your case in court. If our firm represents you in your case, we will often pay for a medical evaluation if you need one.
You need proper medical treatment to recover from your injury. Many people have questions about the best way to get that treatment.
A free consultation with a workers’ compensation attorney provides a good way to get questions answered. I provide free consultations and would be happy to talk to you. To find out more about how a free consultation with me works and how to set one up, just take a look at this article.
If you would like to go ahead and schedule a consultation, it is easy to do. Just call our office at (770) 214-8885 or complete and submit our free consultation request form.
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.
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