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Experiencing a work-related injury or illness that prevents you from continuing to work can be devastating. Beyond coping with your newly diagnosed medical conditions, you may also be facing financial strain or even issues with medical treatment. It is important to understand how a Georgia workers’ compensation claim works, particularly when it comes to choosing or changing the physician(s) treating your diagnoses.
If your employer or the workers’ compensation insurance carrier outright deny your claim by alleging your injury or illness is not covered, you can go to any doctor of your choice for treatment. If the insurer later accepts your claim and acknowledges it is covered by paying workers’ compensation benefits – or, alternatively, the Georgia State Board of Workers’ Compensation (GSBWC) rules your injury or illness is covered – you can choose any of the doctors who have been treating you as your authorized treating physician for your claim. You must, however, first notify your employer.
If you want to change doctors during your workers’ compensation claim, there are certain procedures that must be followed if a sick or injured employee wants to change treating physicians during a workers’ compensation claim. The rules, however, depending on how the initial treating physician was chosen.
If the initial treating doctor came from the employer’s panel of physicians, an employee can simply switch to another physician on the panel. That being said, this can only be done once without needing to obtain approval from the GSBWC prior to changing physicians.
If your employer uses a workers’ compensation managed care organization (WC/MCO), you are required to follow its rules if you want to change treating doctors.
If you choose your own treating physician because the insurer denied your workers’ compensation claim from the start, or your employer did not provide their pre-authorized physicians (a “panel of doctors”) or WC/MCO options, you may change your doctors once without having to go through the panel or the WC/MCO.
Once you have changed your treating physician one time under the above rules, you can request that the workers’ compensation insurance carrier agree to another change. If you are unable to come to an agreement, you can then make a request to the GSBWC that they order the change of physicians. There is a specific form that must be completed to make the request, and a copy should be provided to the workers’ compensation insurance company and your employer. Notably, a Georgia employer may also request a change in treating physicians or treatment provided. But, do not worry, as the employee is afforded an opportunity to object. In fact, an employee or the workers’ compensation insurance company may request a hearing on that specific issue.
Successfully filing a workers’ compensation claim in Georgia can be complicated. Contact the Georgia workers’ compensation attorneys at Christopher Simon Attorney at Law today with any questions you may have regarding your claim. We can help you every step of the way.