Medical Treatment for your workers' compensation claim
If the insurance company has accepted your claim, you may be entitled to reasonable and necessary medical care at the insurance company’s expense. However, obtamedical care through workers’ compensation insurance can be extremely frustrating, and you should always consult an experienced workers’ compensation attorney.
understanding your medical care
Many parameters are set regarding the medical care you may receive through workers' comp insurance. In general, you must treat with a pre-approved doctor, all treatment recommended by your doctor must be independently approved, and the length of time for which you are entitled to medical care is limited.
Panel of physicians
Under Georgia law, if an employer has three or more employees, they must carry workers’ compensation insurance. If a company is required to carry workers’ compensation insurance, then they are also required to have a list or “panel” of doctors from which their employees can select a physician.
If an employer has complied with the law and has a valid panel, you must treat with a doctor from that list if you wish to have your medical care covered through workers’ compensation insurance. However, if the employer does not have a valid panel of physicians, you may choose your own doctor, and the insurance company must pay for it.
A valid Panel:
Must list at least 6 physicians who are currently practicing medicine
Must list at least 1 minority physician
Must list at least 1 orthopedic surgeon
Cannot have more than 2 industial clinics
Must contain up-to-date addresses and phone numbers for all listed physicians
Be posted in a conspicuous location and visible to employees
Authorized treating physician (ATP)
The doctor you select from the panel of physicians (or independently if there is no valid panel) is known as your Authorized Treating Physician, commonly referred to as the ATP.
Who you select as your ATP is crucial to your medical care and your workers' compensation claim in general because:
Your ATP determines your course of treatment and makes what they deem to be necessary treatment recommendations and referrals. If you have an overly conservative ATP, you may end up not receiving the quality of care that you need and deserve.
If your ATP takes you out of work, the insurance company must provide weekly compensation to you until the ATP releases you back to work or you are otherwise no longer entitled to financial benefits.
As long as you are treating with your ATP, the insurance company must approve all treatment recommendations and referrals he or she makes. Aditionally, the insurance company must pay for all costs associated with the medical care provided by your ATP.
ONE-time change of physician
It is not uncommon for injured workers to be unhappy with their authorized treating physicians. If you feel like your doctor isn’t listening to your concerns, or if your doctor is not providing adequate treatment for your injuries, you are entitled to select another doctor to become your ATP. However, if the insurance company has a valid panel, you must select another doctor from the panel. Additionally, this may only be done once unless the insurance company approves an additional change.
Idependent medical evaluation (IME)
In addition to your medical treatment with your authorized treating physician, you may be entitled to one independent medical evaluation (a second opinion) with the doctor of your choice, and the insurance company must pay up to $1,200.00 towards the cost of that evaluation.
It is important to note that this evaluation is not treatment. It is simply a second opinion regarding your injuries and treatment. However, it is a great tool to have at your disposal because it serves a few different purposes:
- If your ATP has refused to provide adequate treatment or claims that there is nothing more they can do for you, you may want to get a second opinion to use as evidence that your current ATP is ineffective.
- If your ATP has recommended treatment but the insurance company has denied it, a second opinion to bolster the recommendation of the ATP is helpful in showing the insurance company that the treatment is necessary.
The Insurance Company's IME
The insurance company also has the right to schedule an IME with the doctor of their choice.
Further, since they are paying for it, they can schedule and require you to attend more than one IME if you have multiple injuries.
Duration of treatment
Unless your injuries are catastrophic, you are generally entitled to medical care for up to 400 weeks from the date of your injury. However, that time frame could be cut short due to the following:
Non-Compliance
Passage of Time
Passage of Time
You fail to show up for medical appointments despite being given ample opportunity to attend.
Passage of Time
Passage of Time
Passage of Time
More than 1 year has passed since the last time you sought medical treament for your injuries.
Unrelated Injury
Unrelated Injury
Unrelated Injury
Your ATP determines that your injuries are no longer related to your work accident.
Example: You have a knee injury but you also had pre-existing arthritis in that same knee. The ATP may determine that any remaining pain is related to the arthritis and not the injury itself.
New Accident
Unrelated Injury
Unrelated Injury
You are involved in a subsequent accident that worsens your injury.
Example: You are receiving treatment for a knee sprain. A few months later, you are in a car accident and end up tearing your ACL. In that case, you are no longer entitled to medical care for your knee through workers' comp insurance
Mileage reimbursement
You are entitled to reimbursement for mileage traveled to and form medical appointments and pharmacies so long as those trips are related to your work accident. Reimbursement rates are currently set at $0.70 per mile, and you must submit your mileage reimbursement request within one year of the date the expense was incurred. Once you submit the reimbursement request, the insurance company has 15 days to make the payment or face late penalties.
Contact Us
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The Barionnette & Eisenhower Law Firm, LLC
2310 Parklake Drive Northeast, Suite 460, Atlanta, GA, USA
The Barionnette & Eisenhower Law Firm, LLC
2310 Parklake Drive, Suite 460 - Atlanta, GA 30345
P: 404-225-1501 — F: 678-305-0908