Workers' Comp Medical Issues FAQs
One of the biggest concerns most people have about workers’ compensation claims concerns coverage of medical bills. You deserve to know how your medical costs are going to be covered while you are out of work.
Medical coverage can be incredibly complicated, so it will be important for you to ensure that you retain legal counsel for assistance with every aspect of seeking help with medical bills. You will want to contact an Atlanta workers’ compensation lawyer when you are preparing to file any kind of workers’ compensation claim.
What Do I Do About a Doctor?
Your employer has to post information identifying their preferred medical care providers. An employer can satisfy this requirement in one of two ways.
First, there is a traditional panel of physicians that consists of a minimum of six doctors, and you are allowed to pick any one of those six. The State Board of Workers’ Compensation (SBWC) can grant exceptions to the required size of the panel when it is demonstrated that six physicians or groups of physicians are not reasonably accessible.
A panel has to include one orthopedic physician and not more than two industrial clinics and when possible, a minority physician has to be included. You are allowed to make one change to another doctor on the list without the permission of your employer.
The employer can also post the name of the Workers’ Compensation Managed Care Organization (WC/MCO) certified by the SBWC which your employer has contracted with to provide medical services. Your employer has to give you a notice of the eligible medical service providers and also post a 24-hour toll-free number for the managed care organization.
A managed care representative should assist you in scheduling an appointment with the eligible medical provider of your choice. You can make one change to another eligible physician at any time without the permission of your employer.
If I see my own Personal Physician for an Injury on the Job, Will the Treatment be Covered?
No. The law again requires you to select from the panel of physicians.
If you choose to see a doctor who is not listed on the panel of physicians, it can be considered unauthorized treatment, and workers’ compensation will not be responsible for any charges. When you are dissatisfied with your first selection, you can make one change to another physician within the posted panel.
Any further changes require approval from an Association County Commissioners of Georgia (ACCG) claims examiner or the SBWC.
Who Pays for the Doctor?
Your company’s workers’ compensation insurance carrier should pay for all authorized medical treatment, provided that the treatment is for an on-the-job injury.
What Kinds of Medical Treatment Will be Paid?
Every authorized doctor bill, hospital bill, physical therapy, prescription, and necessary travel expense should be covered when an injury or illness is caused by an accident on the job. You can also be entitled to medical and vocational rehabilitation.
Are Workers’ Comp Benefits Available for Repetitive Stress Injuries?
Yes, repetitive stress injuries resulting from a job may be covered as workplace injuries in most cases. Examples of these injuries include carpal tunnel syndrome or damage to your back or knees resulting from repetitive lifting at work.
It will often be required that you prove that an injury was caused by your specific job duties. This means that if you develop carpal tunnel syndrome, but you engaged in frequent, repetitive movements with your hands outside the workplace such as typing or using a keyboard at home or you have a family history of carpal tunnel syndrome, your employer could argue your injury was the result of those conditions rather than your job.
Such denials are usually not valid, but employers are willing to use anything to deny a workers’ compensation claim. Medical testing will be important for confirming a repetitive motion injury.
When Will Consent be Required?
Verbal or written consent from an injured worker will be required for a case manager to work directly with an injured worker. Written consent from an injured worker is required when a case manager intends to attend any medical appointment with the injured worker.
Nothing prevents a case manager from obtaining written consent as part of their best practices. An injured worker has to receive written notification that consent may be refused/withdrawn at any time.
Attorney for Workers’ Compensation Claims in Atlanta
Did you suffer a serious injury on the job in the Atlanta area? Parsons & Associates, P.C. represents clients all over Georgia and can fight to make sure that you get every last dollar you are entitled to.
Our firm knows how challenging workers’ compensation cases can be for most people and we try to streamline the process for you to make everything easier. You are able to call us or contact us online to receive a free consultation so we can further discuss your case.