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Ocga A 349201 Selection Of Physician From Panel Of Physicians Change Of Physician Or Treatment Liability Of Employer For Failure To Maintain Panel

(a)  As used in this Code section, the term “physician” shall include any person licensed to practice a healing art and any remedial treatment and care in the State of Georgia.

(b)  The employer may satisfy the requirements for furnishing medical care under Code Section 34-9-200 in one of the following manners:

(1)  The employer shall maintain a list of at least six physicians or professional associations or corporations of physicians who are reasonably accessible to the employees; provided, however, that the board may grant exceptions to the required size of the panel where it is demonstrated that more than four physicians or groups of physicians are not reasonably accessible.  This list shall be known as the “Panel of Physicians.”  At least one of the physicians must practice the specialty of orthopedic surgery.  Not more than two industrial clinics shall be included on the panel.  An employee may accept the services of a physician selected by the employer from the panel or may select another physician from the panel.  The physicians selected under this subsection from the panel may arrange for any consultation, referral, and extraordinary or other specialized medical services as the nature of the injury shall require without prior authorization from the board; provided, however, that any medical practitioner providing services as arranged by a primary authorized treating physician under this subsection shall not be permitted to arrange for any additional referrals.  The employee may make one change from one physician to another on the same panel without prior authorization of the board;

(2)  The employer may maintain a list of physicians in conformity with the guidelines and criteria established and contained in the Rules and Regulations of the State Board of Workers’ Compensation.  This list shall be known as the “Conformed Panel of Physicians.”  An employee may obtain the services of any physician from the conformed panel and may thereafter also elect to change to another physician on the panel without prior authorization of the board.  The physician so selected will then become the primary authorized treating physician in control of the employee’s medical care and may arrange for any consultation, referral, and extraordinary or other specialized medical services as the nature of the injury shall require without prior authorization by the board; provided, however, that any of the physicians to whom the employee is referred by the primary authorized treating physician shall not be permitted to arrange for any additional referrals; or

(3)  A self-insured employer or the workers’ compensation insurer of an employer may contract with a managed care organization certified pursuant to Code Section 34-9-208 for medical services required by this chapter to be provided to injured employees.  Medical services provided under this paragraph shall be known as “Managed Care Organization Procedures.”  Those employees who are subject to the contract shall receive medical services in the manner prescribed in the contract. Each such contract must comply with the certification standards provided in Code Section 34-9-208.  Self-insured employers or workers’ compensation insurers who contract with a managed care organization for medical services shall give notice to the employees of the eligible medical service providers and such other information regarding the contract and manner of receiving medical services as the board may prescribe.

(c)  Consistent with the method elected under subsection (b) of this Code section, the employer shall post the Panel of Physicians or Conformed Panel of Physicians or Managed Care Organization Procedures in prominent places upon the business premises and otherwise take all reasonable measures to ensure that employees:

(1)  Understand the function of the panel or managed care organization procedures and the employee’s right to select a physician therefrom in case of injury; and

(2)  Are given appropriate assistance in contacting panel or managed care organization members when necessary.

(d)  Notwithstanding the other provisions contained in this Code section, if an inability to make a selection of a physician as prescribed in this Code section is the result of an emergency or similarly justifiable reason, the selection requirements of this Code section shall not apply as long as such inability persists.

(e)  Upon the request of an employee or an employer, or upon its own motion, the board may order a change of physician or treatment as provided under Code Section 34-9-200.

(f)  If the employer fails to provide any of the procedures for selection of physicians as set forth in subsection (c) of this Code section, an employee may select any physician to render service at the expense of the employer.

(g)  The board shall promulgate rules and regulations to ensure, whenever feasible, the participation of minority physicians on panels of physicians maintained by employers or in managed care organizations pursuant to this Code section.

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