Referrals And The Role Of The Authorized Treating Physician
Published: 5/2/2025
The Authorized Treating Physician bears the sole responsibility of making referrals.
Referrals Generally
In Georgia workers’ compensation, The authorized treating physician (ATP) is the doctor who provides medical care and treatment to an injured worker. The ATP plays a crucial role in the workers’ compensation process, as they are responsible for diagnosing the injury, recommending treatment, and determining the injured worker’s ability to return to work.
Another one of the ATP’s key responsibilities is to refer the injured worker to specialists or other healthcare providers when necessary. This is important because some injuries may require specialized care that the ATP may not be able to provide.
There are no providor networks for referrals in Georgia workers’ compensation. The workers compensation insurance company cannot restrict the physician’s clinical judgment in making referrals to specific providors. The ATP is the sole gatekeeper for all referrals.
A major problem in workers’ compensation is that insurance companies will spread misinformation about the ATP’s ability to refer. However, as cited below, the ATP’s right to exercise their clinincal judgment to make referrals in inviolate.
National ethics rules that speak directly to referrals
| Source | Core duty |
|---|---|
| AMA Code of Medical Ethics Op. 1.2.3 “Consultation, Referral & Second Opinions” | A referral decision must be based solely on the patient’s medical need. |
| AMA Code Op. 8.13 “Managed Care” | Even when acting as a cost-containment “gatekeeper,” the physician’s first obligation is patient advocacy. Physicians must continue to place the interests of their patients first. |
| AMA Code Op. 9.6.9 “Physician Self-Referral” | Bars referrals that enrich the doctor unless disclosure and patient-welfare tests are met—relevant because WC insurers sometimes steer to captive clinics. |
Georgia-specific law & guidance
| Georgia authority | What it says about referrals |
|---|---|
| O.C.G.A. § 34-9-201(b)(1) and Board Rule 201 | The authorized treating physician (ATP) “may arrange for any consultation, referral, and extraordinary or other specialized medical services as the nature of the injury shall require without prior authorization from the board.” A referred doctor may not generate further referrals—control stays with the ATP. |
| SBWC “Best Practices—Selecting Physicians for Your Panel” | Employers are told to pick doctors “who are not afraid to refer the injured worker to a specialist if necessary,” because letting a case linger without progress drives up costs and litigation. |
| City of Atlanta v. Sebastian (2023) | Confirms that only the ATP’s opinion controls benefit suspension and labels the ATP the sole gatekeeper for all referrals. |
| Georgia Composite Medical Board Rule 360-3-.02(14) | Defines as unprofessional conduct the failure to use “history, physical exam, laboratory, or radiographic studies… when applicable, to diagnose a medical problem.” If the ATP lacks the specialty tools and refuses to refer, this rule applies. |
| Georgia Composite Medical Board Rule 360-3-.02(18) | Defines as unprofessional conduct as “Any other practice determined to be below the minimal standards of acceptable and prevailing practice.” As clearly defined by Georgia law, a pysician’s role as an ATP in a workers’ comp claim requires them to make referrals as medically necessary. |
Example of an ethical delima for a treating physician
Imagine an injured worker with a knee injury. The ATP is an othopedic surgeon who specializes in knee injuries. However, the injured workers also started to experience hip pain due to their altered gait. The ATP is not a hip specialist and does not treat the hip. The workers’ compensation insurance company may put pressure on the medical provider to refer the injured worker to a specific doctor or not make a referral at all. Unfortunately, this is a common scenario in workers’ compensation cases.
- If the hip injury is reasonably related to the work injury, the ATP is ethically obligated to refer the injured worker to a hip specialist for evaluation and treatment of the hip pain.
- The ATP should choose the referral physician based on the patient’s medical needs, not the insurance company’s preferences.
Insurance adjusters, case managers, and insurance attorneys often try to exert improper influence over the ATP’s decision-making process.
Georgia worker’s compensation insurance companies have been known to lie to medical providers about the law. They may tell the ATP that they are not allowed to refer the injured worker to a specific doctor. For example, saying a referral can only be to a “hip specialist” without specifying a particular hip doctor. This is false. The ATP has the right to refer the injured worker to any doctor they choose, as long as it is medically necessary.
A generalized referral (without specifying the provider) would allow the insurance adjuster to choose the doctor to treat the hip injury. If the ATP goes along with this request, they are violating their ethical obligations. They would abdicating their role as the gatekeeper for referrals and their obligation to make referrals based on their own clinical judgment of the patient’s needs. An insurance adjuster, with no medical training, should not be in overriding the providor’s clinical judgment as to which referral provider is best suited to the patient’s needs. It is the soley Authorized Treating Physician’s responsibility to choose the best doctor for the injured worker’s needs.
Advice for injured workers
If you are an injured worker, and your authorized treating physician tells you that they cannot refer you to a specialist, this is a red flag. Your ATP is the gatekeeper for all referrals, and they have the right to refer you to any doctor they choose for your work injuries. You should be cognizant that medical providers are subject to conflicts of interest and may be influenced by the insurance company. If you feel that your ATP is not acting in your best interests, or if they are refusing to refer you to a specialist when it is medically necessary, you should consider contacting an attorney to adise you on your options to switch doctors.
