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What are your rights to medical benefits in Georgia?


MEDICAL BENEFITS GUIDE


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

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.

What types of injuries are covered?


Sometimes workers’ comp insurance companies will try to deny pre-existing conditions. 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.

Workers compensation also covers repetitive motion injuries. If the reprititve use of a body part at work causes an injury, then it will be covered by workers' comp. These types of injuries can be just as severe and debilitating as traumatic injuries.

Did you know you can get paid for travel expenses to the doctos 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.

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.

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.

Additionally, you always have a right to make a one time switch to another doctor on the employer's panel of physicians. This is an absolute right and you do not need the permission of workers' comp to do this. You also have a right to petition the State Board of Workers Compensation to allow you to change doctors to someone outside of your employer's panel of physicians.

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