Dispute About Care

What can you do if the workers’ compensation doctor is providing substandard care?  Perhaps you are just got getting any better, or maybe the industrial clinic doctor has released you back to full duty work even though you can barely move.  What can you do?

The Georgia workers’ compensation law provides us with a number of alternatives when there is a dispute about your medical care.

First, you have the right to “one free switch” – that is, you can change from one posted panel doctor to another.  You do not need permission to do this and the insurance company cannot object.   You can, however, only opportunity for this “one free switch” so use it carefully.

Second, you have the right to demand a “claimant’s IME.”  (“IME” stands for Independent Medical Exam).   Here, too, you can only assert this right once and only under certain circumstances but it does give you the right to have a specialist meet with you and review your records.  I often utilize the claimant’s IME to support a Request for Change in Treating Physician.

Third, you can file a Request for Change in Treating Physician with the State Board of Workers’ Compensation.  I use this option when I feel that my client is not getting the proper care and that no progress is being made with medical treatment.

Usually, I will try to negotiate for a change in treating physician with the insurance adjustor or with the defense lawyer.  If the adjustor is behaving reasonably, I may be able to reach agreement before actually filing a motion; otherwise, once I file a request for a hearing on this issue, your file will be assigned to a defense lawyer.

Hearings on Requests for Change in Treating Physician rarely occur because I am usually able to come to an agreement with the other side but I have litigated this issue before a workers’ comp administrative law judge.

I think that one of the most surprising realities about Georgia workers’ compensation relates to medical care.  Most of us are raised to honor and respect doctors and to believe that most doctors are honorable people who have our best interests at heart.   Unfortunately in the workers’ compensation world, money and the source of payment does become a factor.

There are a number of doctors in practice throughout the state who get most or all of their business from workers’ compensation insurance companies.   If you see a medical practice that includes the words “industrial clinic” or “evaluation center” there is a good chance that the doctor working therein has an on-going financial relationship with one or more insurance companies.

Insurance companies make money by keeping their costs down and health care providers that work for insurance companies will generally be less likely to order expensive diagnostic tests, recommend surgery or keep an injured worker out on temporary total disability for an extended period of time.

Sometimes the influence of the insurance company is subtle and sometimes it is quite overt.  Either way, because I have been assisting my clients with medical issues for over 20 years, I can offer my clients perspective about what is supposed to happen.

If you want to discuss your workers’ compensation medical care with me, please do not hesitate to call me at 770-351-0801 or email.