Workers' Compensation Physician Choices
When an employee is injured on the job, workers' compensation insurance requires that the employer have a list of physicians ready to treat any injury. It is up to the employers to choose the physicians who will treat all employees injured on the job, within the guidelines of the Georgia State Board of Workers' Compensation (SBWC).
It is up to the employer to select the physicians their employees will have access to under Workers' Compensation Insurance. SBWC requires employers to choose one of three options in determining their list of physicians. The minimum number of physicians an employer should have on their panel is six, including “one orthopedic surgeon, a minority physician and four other properly qualified physicians, but no more than two industrial clinics.” An employer can opt to have a ten-physician panel, called a conformed panel, with the same requirements as the first option, but it will also include a general surgeon and a chiropractor. The third option is to use a managed care organization (MCO) “to provide a health care program for injured workers.” The SBWC requires an MCO “to include: health care providers and financial incentives to reduce service costs and utilization, peer review, service utilization review, dispute resolution, safety and an early return-to-work program.”
The SBWC describes the benefits of the different programs:
The Panel of Physicians is very structured and allows the employer to keep control of the medical treatment of the injured workers.
The Conformed Panel is also structured but allows the employees an expanded choice of physicians.
The MCO is greatly expanded and might lend itself to organizations with multiple locations in the state. The MCO, like a PPO, will offer discounts. The MCO is a complete program of managed care for the injured worker.
The SBWC recommends that employers have their chosen physicians visit the workplace to be knowledgeable of the types of work performed. This will give the doctor a better understanding of the possible injuries the workers could suffer to be prepared to assist them.
The SBWC recommends that employers choose physicians who will listen to injured employees and assist workers' compensation examiners in the processing of claims. It is also important that a physician will recommend an injured employee to a specialist if it is needed. This is recommended so “the medical treatment does not go on indefinitely,” and so that “the employee sees improvement in his/her medical condition, which relieves stress and anxiety.”
The SBWC recommends that employers keep track of the physicians they choose and “review the panel every six months to determine that all of the physicians listed are still valid and are doing a good job for the company and the employees.”
Even with well-chosen doctors who do communicate with workers' compensation examiners, it can be in an injured employee's best interest to retain an attorney. An attorney can assist with making sure you receive the benefits you are entitled to. Contact our knowledgeable attorney about assistance with your workers' compensation claim.