Atlanta Workers Compensation Law : Atlanta Workers' Compensation Lawyer & Attorney : Seth Bader Law Firm : Construction Accidents, Repetitive Motion Injuries, Disability : Atlanta, Marietta, Roswell, Georgia

(a)

(1)  The employer/insurer have a duty to provide all reasonable and necessary medical treatment in a timely manner and to give appropriate assistance in contacting medical providers when necessary.  The employee has a continuing obligation to cooperate with medical providers in the course of their treatment for work related injuries.

(2)  Payment of compensation for costs by the employer or its insurer directly to the providers of medical, surgical and hospital care and other treatment, items, or services on behalf of the employee or directly to the employee shall satisfy employer's obligation to furnish the employee compensation for costs of such medical, surgical, hospital care and other treatment, items and services provided for by O.C.G.A. § 34-9-200(a).

(b)

(1)  Changes in treatment.  Except as provided in subsection (b) of O.C.G.A. § 34-9-201, changes of physician or treatment are made only by agreement of the parties or by order of the Board.  If there has been no hearing requested, a party requesting a change shall make a good faith effort to reach agreement on the change before requesting an order from the Board.

If an agreement cannot be reached, the party requesting the change shall make the request on a Form WC-200b.  When filing the WC-200b, the moving party shall sign the Form WC-200b, attach supporting documentation including a separate certificate of service identifying the names and addresses serviced attached to the end of the request, and serve a copy on all counsel and unrepresented parties.  In cases that have been designated as "Medical Only", the requesting party shall file a Form WC-14 Notice of Claim or a Form WC-1 along with the Form WC-200b in order for the Board to process the request.  The party making the request must specify the reason for the requested change, as well as the date that the change shall be effective.  If the argument in support of the request is based on testimony, then an affidavit must be attached to the form, and if the argument refers to documents, then a copy of the documents must be attached.  Do not use tabs to separate documents used as evidence.  If the Board grants a change, the effective date will be the date that the Form WC-200b was filed, unless otherwise specified.

Any party who objects to the request for a change of physician or treatment shall also file their objection on a Form WC-200b with the Board within 15 days of the date of the certificate of service on the request, including a separate certificate of service identifying the names and addresses served attached to the end of the objection, and serving a copy on all unrepresented parties and counsel.  Affidavits and documents must be attached as specified above.

All requests and objections to change of physicians shall be filed on a Form WC-200b and shall be limited to 50 pages, including briefs and exhibits, unless otherwise permitted by an Administrative Law Judge or the Board.

Whenever the pending issues in a request resolve, in part or in whole, the parties or attorneys shall immediately notify the assigned Administrative Law Judge:

(1)  first, by telephone call; and

(2)  if so instructed, by subsequent written or electronic confirmation.

Any party or attorney who fails to follow this procedure, and who is unable to show good cause for such failure, may be subject to civil penalties and/or assessed attorney's fees.

If a hearing has been requested, the party requesting a change of physician or treatment may include the request in the original request for hearing, or amend the hearing request within 15 days prior to the date of the hearing to include the issue of change of physician or treatment.  Upon consideration of the evidence, the Administrative Law Judge will render a decision on all the issues presented.

If the parties agree on a change of physician or treatment, a properly executed Form WC-200a may be filed with the Board, with copies provided to the named medical provider(s) and parties to the claim, which form shall be deemed approved and made the order of the Board pursuant to O.C.G.A. § 34-9-200(b), unless otherwise ordered by the Board.

(2)  The party requesting/objecting to a change in physician shall set forth reasons why the change will/will not benefit the employee, or provide the employee with medical care reasonably required to effect a cure, give relief, or restore the employee to suitable employment.  Factors which may be considered in support of the request/objection may include, but are not limited to, the following:

(i)  Proximity of physician's office to employee's residence;

(ii)  Accessibility of physician to employee;

(iii)  Excessive/redundant performance of medical procedures;

(iv)  Necessity for specialized medical care;

(v)  Language barrier;

(vi)  Referral by authorized physician;

(vii)  Noncompliance of physician with Board Rules and procedures;

(viii)  Panel of physicians;

(ix)  Duration of treatment without appreciable improvement;

(x)  Number of prior treating physicians;

(xi)  Prior requests for change of physician/treatment;

(xii)  Employee released to normal duty work by current authorized trea ting physician;

(xiii)  Current physician indicates nothing more to offer.

(3)  When filing a motion for reconsideration, the parties or attorneys shall:

(1)  immediately notify the Board or assigned Administrative Law Judge by telephone call;

(2)  use the ICMS doc-type labeled motion for reconsideration;

(3)  limit their motion to 20 pages, including briefs and exhibits, unless otherwise permitted by the Board or an Administrative Law Judge; and

(4)  serve a copy on all counsel and unrepresented parties, along with supporting documents, including a separate certificate of service identifying the names and addresses served.

(c)

(1)  As long as an employee is receiving compensation, he or she shall submit himself or herself to examination by the authorized treating physician scheduled by the employer/insurer at reasonable times and with reasonable notice.  If the employee refuses to submit himself or herself to or in any way obstructs such an examination requested by and provided for by the employer, upon order of the board his or her right to compensation shall be suspended until such refusal or objection ceases and no compensation shall at any time be payable for the period of suspension unless in the opinion of the board the circumstances justify the refusal or obstruction.

(2)  Nothing contained herein shall be construed to abridge the employee's continued right to schedule his/her appointments for authorized medical treatment.

(d) The employer/insurer may suspend weekly benefits for refusal of the employee to submit to treatment only by order of the Board.

(e)  Medical Reports

The employer/insurer shall not file with the Board a medical report for any injury which occurred after January 1, 1989, except as follows:

(1)  The report or its attachments contains a permanent partial disability rating (file within 10 days of employer/insurer's receipt);

(2)  A rehabilitation plan is filed with the Board. In such instance the medical reports shall be filed with the rehabilitation plan;

(3)  Medical reports are requested by the Board (file within 10 days of request.)  Any additional medical reports required shall be filed within 10 days of the employer/insurer's receipt of same.  The employer/insurer shall maintain copies of all medical reports in their files and shall not file medical reports except in compliance with this Rule.

(f)

(1)  Requests for Medical Information.  The employee shall, upon the request of the employer/insurer, furnish copies of all medical records and reports which are in his/her possession concerning the treatment for the accident which is the subject of the claim.  The employee shall furnish the copies within 30 days of the date of the request.  The employer/insurer shall pay the reasonable cost of the copies as provided by the Board-approved fee schedule.

(2) The employer/insurer shall, upon the request of the employee, furnish a copy of the posted panel of physicians, and copies of all medical records and reports in their possession concerning the treatment for the accident which is the subject of the claim, and shall, upon request of the employee, furnish copies of all medical records and reports which were obtained with a release of the employee provided pursuant to O.C.G.A. § 34-9-207(b), within 30 days of the date of the request at no expense to the employee.

(3)  Upon failure of either party to furnish information as provided above, the physician or other medical providers shall, upon request, furnish copies of all medical reports and bills in their possession concerning the treatment for the accident which is the subject of the claim, at no expense to the employee or his/her attorney.  A reasonable cost for copies pursuant to the fee schedule may be charged against the party determined to be responsible for payment of medical expenses.  Nothing in this Rule shall limit an employee's right to obtain a complete copy of his/her medical records from any health care provider.

(g)  Physicians as defined in O.C.G.A. § 34-9-201(a) may be called upon and may be issued a subpoena requiring their testimony as expert witnesses based upon their examinations and treatment of employees alleging work-related injuries.  In lieu of live testimony at hearings in cases pending before the State Board of Workers' Compensation regarding matters subject to the Act, as permitted under O.C.G.A. § 24-10-24, depositions may be taken pursuant to O.C.G.A. § 24-9-26 et seq and O.C.G.A. § 34-9-102(d)(3), and said physicians shall be compensated for their preparation time and actual time pursuant to the provisions of the Board approved Fee Schedule or by a fee agreement agreed to by the parties and the physician.

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(a)  The employer may satisfy the requirements for furnishing medical care under O.C.G.A. § 34-9-200 in one of the following manners:

(1)

(i)  The employer may maintain a traditional posted panel of physicians that shall consist of at least six non-associated physicians, but is not limited to a minimum of six.  However, the Board may grant exceptions to the required size of the panel where it is demonstrated that more than four physicians or groups of physicians are not reasonably accessible.  The physicians selected under this subsection from the panel 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; provided, however, that any medical practitioner providing services as arranged by a primary authorized treating physician under O.C.G.A. § 34-9-201(b)(1) shall not be permitted to arrange for any additional referrals.  The physicians and groups listed on the panel shall be counted as a separate choice from the others listed only if they are not associated with the other physicians and groups listed on the panel.  The minimum panel shall include an orthopedic physician, and no more than two physicians shall be from industrial clinics.  Further, this panel shall include one minority physician.  The minority physician so selected must practice within the State of Georgia or be reasonably accessible to the employee's residence.  "Minority" shall be defined as a group which has been subjected to prejudice based on race, color, sex, handicap or national origin, including, but not limited to Black Americans, Hispanic Americans, Native Americans or Asian Americans.  Failure to include one minority physician on the panel does not necessarily render the panel invalid.  The Board reserves the right to allow exceptions when warranted.  The employee may make one change from one physician to another on the same panel without prior authorization of the Board.  The party which challenges the validity of a panel shall have the burden of proving that the panel violates the provisions of O.C.G.A. § 34-9-201 and Board Rule 201.

(ii)  In the event that the Board has granted any exceptions to the panel requirements, all exceptions must be posted at the same location as the panel.

(2)  Conformed Panel of Physicians.  The employer may maintain a list of physicians that shall be known as the "conformed panel of physicians," which shall include a minimum of ten physicians, or professional associations, reasonably accessible to employees and providing the same types of healthcare services specified in Board Rule 201(a)(1) and the following additional healthcare services: general surgeons and chiropractors.  The physicians and groups listed on the panel shall be counted as a separate choice from the others listed only if they are not associated with other physicians and groups listed on the panel.  Further, this panel shall include one minority physician as specified in Board Rule 201(a)(1).  An employee may obtain the services of any physician from the conformed panel and may thereafter also elect to change to another physician on the panel without prior authorization of the Board.  The physician so selected will then become the authorized treating physician in control of the employee's medical care and may arrange for any consultation, referral, and extraordinary or other specialized medical services as the nature of the injury shall require without prior authorization of the Board; provided, however, that any of the physicians to whom the employee is referred by the primary authorized treating physician shall not be permitted to arrange for any additional referrals.  The party which challenges the validity of the conformed panel shall have the burden of proving that the panel violates the provisions herein.

(3)  An employer or the workers' compensation insurer of an employer may contract with a workers' compensation managed care organization certified pursuant to O.C.G.A. § 34-9-208 and Board Rule 208.  A "workers' compensation managed care organization" (hereinafter "WC/MCO") means a plan certified by the Board that provides for the delivery and management of treatment to injured employees under the Georgia Workers' Compensation Act.  The party which challenges the validity of the WC/MCO panel shall have the burden of proving that the panel violates the provisions herein.  An employer utilizing a WC/MCO may satisfy the notice requirements of O.C.G.A. § 34-9-201(c) by posting a notice in prominent places upon the business premises which includes the following information:

(A)  The employer has enrolled with the specified WC/MCO to provide all necessary medical treatment for workers' compensation injuries.  An employee with an injury prior to enrollment may continue to receive treatment from the non-participating authorized treating physician until the employee elects to utilize the WC/MCO;

(B)  The effective date of the WC/MCO;

(C)  The georgraphical service area (by counties);

(D)  The telephone number and address of the administrator for the employer and/or WC/MCO who can answer questions about the managed care plan;

(E)  How the employee can access care with the WC/MCO and the toll-free 24-hour telephone number of the managed care plan that informs employees of available services.

(b)  The employer/insurer cannot restrict treatment of the employee to the panel of physicians, conformed panel of physicians, or WC/MCO when the claim has been controverted.  However, if the controverted claim is subsequently found to be or is accepted as compensable, the employee is authorized to select one of the physicians who has provided treatment for the work-related injury prior to the finding or acceptance of compensability, and after notice has been given to the employer, that physician so selected becomes the authorized treating physician.  The employee may thereafter make one change from that physician to another physician without approval of the employer and without an order of the Board.  However, any further change of physician or treatment must be in accordance with O.C.G.A. § 34-9-200 and Board Rule 200.

(c)  When a case has not been controverted but the employer fails to provide any of the procedures for selection of physicians as set forth in O.C.G.A. § 34-9-201(c), the employee is authorized to select a physician who is not listed on the employer's posted panel of physicians, conformed panel of physicians or WC/MCO.  After notice has been given to the employer, that physician so selected becomes the authorized treating physician, and the employee may make one change from that physician to another physician without approval of the employer and without an order of the Board.  However, any further change of physician or treatment must be in accordance with O.C.G.A. § 34-9-200 and Board Rule 200.

(d)  A party requesting a change of physician must do so in the manner prescribed by Board Rule 200.

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This report and/or the HCFA 1500, HCFA 1450, and/or UB92 shall be completed and filed as follows:

(A)  The attending physician or other practitioner makes the report and forwards it along with office notes and other narratives to the employer/insurer as follows:

(i)  Within seven days of initial treatment;

(ii)  Upon the employee's discharge by the attending physician;

(iii)  At least every three months until the employee is discharged;

(iv)  Upon the employee's release to return to work;

(v)  When a permanent partial disability rating is determined.

(vi)  Pursuant to Rule 203(b).

(B)  The employer/insurer shall file the report including office notes and narratives with the Board within 10 days after receipt as follows:

(i)  When the report contains a permanent partial disability rating;

(ii)  Upon request of the Board; and,

(iii)  To comply with other rules and regulations of the Board.

(C)  The employer/insurer shall maintain copies of all medical reports and attachments in their files and shall not file medical reports except in compliance with this rule and Rule 200(c).

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A party who requests a change of physician or additional treatment without consent, or who objects to a request which has been made, shall file this form with the Board, and serve a copy on all counsel and unrepresented parties.  Objections must be filed within 15 days of the date on the certificate of service on the request.

• Form WC-200b/Request/Objection for Change of Physician/Additional Treatment
  

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• Form WC-P1/Panel of Physicians
  

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See Board Rule 201.

• WC-P2/Conformed Panel of Physicians

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To be utilized only by employers/insurers contracted with a Board Certified Managed Care Organization.  See Board Rule 201.

• WC-P3/WC/MCO Panel

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