Like other types of insurance, workers’ compensation insurance policies have a system of provider networks. This means that the insurance policy for which your employer contracts will have a limited range of options for treating physicians in the case of employee injuries. Employers are required to provide workers with a “Physician panel” (or, a list of covered physicians) from which an injured employee may seek care. Medical service fees are negotiated in advance between providers and insurers, subject to approval by the Workers’ Compensation Board. This post discusses what the law requires of employers with respect to physician panels and what your legal options are if you do not like the options you are given.
Employers are required to “maintain a list of at least six physicians or professional associations or corporations of physicians who are reasonably accessible to the employees.” GA Code § 34-9-201(b)(1) (2014). This minimum number may be reduced by the board of workers’ compensation if the employer can make a showing that there are not enough reasonably accessible physicians. Reasonable accessibility is a question of geography, so the more remote the workplace, the more likely the company is to qualify for this exception.
If an employee is injured, he or she may seek treatment from any physician on the panel and the employer’s insurer should cover it. Among the panel, at least one of the physicians must practice orthopedic surgery, and a maximum of two providers on the list may be “industrial clinics.” Physicians on the panel may make any consultations, referrals, or other medical treatments and decisions without prior authorization from the board. The employee may also switch from one provider on the list to another provider without prior approval.
In addition to switching physicians within the panel, the employee may seek leave to obtain the care of a different physician or seek a different treatment with board approval. Similarly, the employer is permitted to request these changes. This situation is most common when there is a dispute between the employee and the employer about the severity of the injury and the treatments required.
According to the Workers’ Compensation Board’s Employer’s Manual (p. 17-18), employers must also provide a “conformed panel,” which consists of ten physicians and must include general surgeons and a chiropractor. Access to treatment from this panel is available upon request and approval of the board. The manual further specifies that in a “true emergency situation, the nearest emergency location can be used, but “only to the extent of the emergency.” All follow-up treatment is to be provided by an authorized panel physician.
As a worker, if you seek the care of your primary care physician, your costs are unlikely to be covered by workers’ compensation. In non-emergency situations, you must seek board approval to obtain treatment from a physician off the panel.
Contact a Georgia Workers’ Compensation Attorney
One of the most common disputes in workers’ compensation claims is over what medical treatments are required, and whether they should be covered. In creating their panel, there is a temptation for employers to seek out the more “conservative” doctors who are more likely to approve a patient to return to work and less likely to recommend costly or experimental treatments. Because employers are required to pay for all your related medical expenses, they often try to keep costs down. This is why insurers negotiate rates in advance. There is a real danger to the patient, however, when a third party interested in controlling costs has too much control over your treatment.
Contact a Workers’ Compensation Lawyer Today
If you are in a dispute with your employer over the treatment required for your workplace injuries, you likely need the help of an attorney to represent you before the Workers’ Compensation Board. Whether you are seeking to consult a different physician, or whether your employer is unhappy with your current physician’s diagnosis and treatment plan, there is a legal process for resolving these disputes. The attorneys at the Bader Scott Injury Lawyers know how to fight for your right to seek the doctor of your choice and obtain the treatment you need. Do not be bullied into accepting less treatment than you need, or into returning to work before you are fully recovered. Contact us today to protect your rights.