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Workers' Comp Medical Benefits Guide

Last modified: Dec 12 2020

Worker’s Compensation medical benefits pay for 100% of the cost of your medical treatment for any condition related to your workplace injury.

What are my rights to medical care?

In a typical Worker’s Compensation case the employer has control over the medical treatment. They are required to provide you with a list of doctors. But, you have a right to choose any doctor on the list to treat your workplace injury. This list is called a "panel of physicians". The list of doctors is required to be posted in the workplace and this list must be accessible to you. You’re entitled to choose any doctor that you want off of this list. The list must have at least six doctors on it and one of the doctors must be an orthopedic doctor. And, the list cannot contain more than two industrial clinics (for example, Concentra). If your employer either does not have a list or their list is invalid (for example, it has less than six doctors) then your employer is not allowed to limit your choice of doctors. You can choose any doctor that you want and workers compensation must pay for it.

This is what a "panel of physicians" looks like.

This document is the first thing that you should look for after you have a workplace injury.

Choosing the doctor to treat your injury

Some medical providers have a BIG conflict of interest regarding YOUR medical care. There are some Medical Providers who focus on workers' compensation insurance and get hundreds of patients directly referred to them from the workers compensation insurance companies. One of the biggest mistakes we see is going to an "industrial clinic." These companies know they will get sent more injured workers if they help the insurance company instead of you. Some examples of industrial clinics to avoid are:

  • Concentra
  • Caduceus
  • Nova

This is not a compelete list and you need to be very careful about who you choose to treat your injury. Did the insurance company tell you that you "have to" go to the industrial clinic? This is very common and it is also a straight-up lie. The panel of physicians will often (but not always) label these providers as an "industrial clinic." Clinics will often refuse to put you on a "no work" status, even if you have a serious injury. If you search their website, you may even find them bragging in their marketing materials about how much money they save the insurance company by not taking injured workers out of work. We have even seen clinics that drug test every injured worker, and it doesnt even matter how you got hurt. If a drug test show a positive for a substance like marijuana, they will forward the results to the insurance company so that they can try to deny your claim. If you are not sure what to do, get a free consultation with a workers' comp lawyer who can help you select the doctor.

What if the panel of physicians is invalid?

It is common for employers to have an invalid panel of physicians. For example there might not be enough doctors, the panel might not have an orthopedic doctor, or the doctors on the panel are out of business. In that case, you are entitled to choose your own doctor. The panel must also be posted at a prominent location on the wall at your workplace. Usually it will be posted in a office or a break room. Use your phone to take a picture of the panel.

However, usually the employer and insurance company do not want to acknowledge that their panel is not valid. They will resist letting you choose your own doctor (in clear violation of the law). If your employer's panel of physicians is invalid, you usually need to get a workers compensation lawyer involved to help you pick your own doctor.

Exercising your right to change doctors

If your employer does have a valid panel then you must choose a doctor from their list. If you choose a doctor outside of the panel, then your employer can refuse to pay the bills.

However,, you always have absolute right to make a one time switch to another doctor on the employer's panel of physicians. You do not need the permission of workers' comp to do this.

You don't have to use a doctor from the Employer's list if you have a genuine emergency

There is an exception for emergency treatment. We often see insurance companies try to avoid paying emergency room bills (arguing that the emergency medical provider is not on their panel). In a true emergency, workers compensation insurance is required to cover the treatment.

Exercising your right to get a second opinion

Sometimes you will reach a roadblock in your Worker’s Compensation case because the treating doctor either doesn’t have any treatment to offer you, or he doesn’t think your medical problems are related to the workplace accident. If you received any checks for weekly income benefits within the last 120 days, then you have the right to get a second opinion from a doctor of your choice and workers compensation is required to pay for it.

Delay and denial of medical treatment is very common under George's workers compensation system.

Unfortunetly, workers compensation is not a good system if you want fast medical care. This is especially true if you do not have an attorney. An attorney can help you navigate this complicated system and make sure that necessary treatment gets approved. There are three main ways that the insurance company will try to deny your medical care.

The first way is simply to ignore your doctor's request to authorize the treatment.

Most doctors will not provide treatment until they know the insurance company is going to pay for it. Your doctor will send requests for authorization to the insurance adjuster and they will ignore the request. If the insurance company is ignoring you, your attorney can file a petition for medical treatment with a state board of workers compensation. This is an expediated process that forces the insurance company to either authorize your treatment or give a valid reason why they are denying treatment. This process only takes about one week. Our firm routinely files these petitions on behalf of our clients to help them get the medical treatment that they need.

The second way that insurance companies deny treatment is to say that your injury is not work related.

Sometimes workers’ comp insurance companies will try to claim that your injury is a pre-existing conditions. In this case, you need to speak to an attorney.

An aggravation of a pre-existing condition is covered under Georgia workers compensation. The only way that the insurance company can deny a pre-existing condition, is if the condition has absolutely nothing to do with your workplace injury. An injured worker with a pre-existing condition, is only required to show that the circumstances of the work somehow contributed to making the condition worse. This could mean causing an old condition to flare up, or an increase of pain.

The third way that insurance companies try to deny medical treatment is to say that the treatment is not medically necessary to provide you with releif

If the insurance company is telling you this, you need to get an attorney. Your attorney will file a claim with the State Board of workers compensation requesting authorization of the treatment.

Here is what you need to do immediately after your accident

1. Report the injury to a supervisor. The employer is required to complete an injury report after you notify them.

2. Seek medical treatment. Workers' compensation normally requires your to choose a doctor from the panel of physicians. Going outside the panel may result in workers compensation not paying your bills. However, there is an exception for cases of emergency.

3. Find the panel of physicians and take a picture of it. It must be posted on the wall at work. If you cannot find it, take a picture of the blank walls in the break room or anywhere is it could be. Do NOT let the insurance adjuster bully you or tell you what doctor to see. It is very important that you choose a doctor who will be an advocate for you and not a doctor who will always side with the insurance company. If there is no panel, you can choose any doctor you want.

4. Make sure you tell the treating physician every problem and symptom you are experiencing. The doctor need to create a record in the medical reports. Waiting to report a problem could cause issues in the case later on.

5. Keep detailed records of everything you get from the doctor's office. It is very important to keep copies of the work restrictions from your doctor, because these will effect your right to be paid lost income benefits.

Did you know you can get paid for travel expenses to the doctor's office?

You have a right to get paid 40 cents per mile for your travel expenses. You only have one year to submit the travel expenses to the insurance company. If you wait more than a year, then you waive your right to be reimbursed. This includes trips to the pharmacy and physical therapy. Additionally, workers' comp must provide you with transportation to the doctors office if you are unable to drive.