Most of us take it for granted that we’ll be able to see our preferred doctor for all our health care needs. However, if you have been injured on the job and are seeking workers’ compensation, this may not be the case. You’ll likely be required to choose a provider from your employer’s panel of physicians.
What Is the Panel of Physicians?
The panel of physicians is a group of six or more doctors your employer uses to handle workers’ compensation claims. It must include at least one orthopedic surgeon and at least one minority physician with no more than two industrial clinics. Ideally, all members of the panel should be located within 50 miles from the workplace. The names and contact information for these physicians must be posted in an easily accessible place for all employees to see.
According to the Georgia State Board of Workers’ Compensation, doctors selected for an employer’s panel of physicians should:
- Be skilled in providing care for the most common types of workplace injuries.
- Be willing to listen to an injured worker’s concerns.
- Be aware of company policy regarding light duty work and post-accident drug testing.
- Promptly refer the worker to a specialist, if necessary.
Employers are allowed to regularly review the performance of members of the panel of physicians and replace providers they don’t feel are meeting their needs, as long as they update the posted panel. Some people feel this creates a financial incentive for doctors to keep costs down and recommend that employees return to work as soon as possible. Unfortunately, there are doctors who do just that. An experienced workers' compensation attorney can help identify such providers, and help you choose a doctor on the panel who is more likely to listen to your concerns regarding your work injury.
What Happens If My Employer Doesn’t Have a Panel of Physicians?
Some Georgia employers opt to forgo the panel of physicians in favor of a conformed panel or managed care organization (MCO). A conformed panel is an expanded version of the panel of physicians, consisting of 10 or more providers including a surgeon and a chiropractor. A managed care organization is an outside group contracted to provide health care for injured workers. Employers are required by law to explain how workers should go about seeking medical care under both of these programs.
If your employer fails to use any of the three available options (panel of physicians, conformed panel, or MCO), then the injured worker is free to choose his own doctor. Despite this right, many employers will at least initially refuse to authorize your choice, and will insist that you treat with "the company doctor." If that happens, consult a a workers' compensation attorney right away for guidance.
Wouldn’t It Be Easier to See My Regular Doctor Under My Own Health Insurance?
If you have excellent health insurance benefits, it may be tempting to simply make an appointment with your regular doctor and forgo the panel of physicians. However, doing this will complicate your case and possibly jeopardize your ability to receive workers' compensation income benefits while you are unable to work. You may also lose your job because your disability is not being documented by a company doctor. Even though it may seem inconvenient, it’s in your best interests to work with a doctor listed on the panel of physicians.
Typically, the only situations where it is appropriate for you to start treating with your own doctor is if:
- Your claim is denied.
- Your employer refuses to cooperate with your request for medical treatment.
- Your employer does not have a properly posted panel of physicians.
What Are My Options If I’m Not Satisfied with My Medical Care?
When you’re injured, it’s important to have a care provider you trust and respect. If you’re unsatisfied with the quality of the treatment you are receiving from the doctor you initially selected, you’re allowed one switch to a different doctor on the panel of physicians without having to obtain prior approval. The same rules apply if your employer uses a conformed panel or managed care organization.
If you’re still unsatisfied with your care from the second doctor, under certain circumstances you may be allowed to seek an opinion from a physician of your choosing on a one time basis as an independent medical examination (IME). If it has been less than 120 days since you last received income benefits on your claim, your employer's insurer would have to pay for this IME. If you are concerned about the quality of medical care that you’re receiving for your work injury, or your employer is preventing you from getting treatment, you should consult a skilled workers' compensation attorney as soon as possible to explore your legal options.
Rechtman & Spevak is committed to helping Georgia residents who’ve been hurt on the job receive the workers’ compensation benefits that they are entitled to. Please call 404-355-2688 or fill out our online contact form to schedule a free, no-obligation consultation.