Medical Treatment and Workers’ Compensation

Medical Treatment and Workers’ Compensation

Intended to make things easier for people who are hurt on the job, workers’ compensation can actually be rather hard to understand – for employees AND employers. Fundamentally an accident insurance program, it provides medical, rehabilitation, and disability benefits to help injured workers get back to work or to help the dependents of a worker whose death resulted from a job-related injury. In Georgia, most employers with three or more full-time, part-time, or seasonal employees must carry workers’ compensation insurance. If you want to know for sure, coverage can be verified by going to the Georgia Board of Workers’ Compensation website.

An employee who is injured within the scope and course of employment, or who develops a workplace-related disease or condition, should report it to a supervisor as soon as possible. Waiting too long can jeopardize the chance to receive benefits. In order to get the insurance company to pay the medical bills, injured employees must choose their medical care from a short list of doctors that have been designated by the workers’ compensation insurance carrier as authorized treating physicians.

Employers are required to display contact information about these selected providers through one of two means:

  • Posting a panel of at least six doctors. The panel must include one orthopedic physician and not more than two industrial clinics. A minority physician is also expected to be on the panel where possible. The employee selects one of the physicians, who provides treatment at the employer’s expense.
  • Posting the name of the Workers’ Compensation Managed Care Organization (WC/MCO) that the employer has contracted with to provide medical services. Notice of the eligible medical service providers must be given, as well as a 24-hour toll-free number for the MCO. An MCO representative then assists the employee in making an appointment with an eligible medical provider.

In either scenario, the employee has the right to change one time to another pre-approved physician without the authorization of the Board, the insurance company, or the employer. An injured employee also has the right to an independent medical examination, to be paid for by the insurance company, but it covers only one visit and must be within 120 days of receiving any benefits.

Necessary medical expenses incurred under the direction of an authorized treating physician are completely covered, including all doctor bills, hospital bills, surgeries, physical therapy, medications, and even travel expenses to and from health care providers. Payment for medical and vocational rehabilitation are also available in some circumstances. Experimental or investigative treatments or therapies are generally not covered, but a skilled attorney might be able to get reimbursement.

A worker who incurred an employment-related injury on or before June 30, 2013, is entitled to lifetime medical benefits. Accidents that occurred on or after July 1, 2013, are limited to a maximum period of 400 weeks from the accident date. Regardless of date, catastrophically injured workers may be entitled to lifetime medical benefits, depending on the circumstances.

If you have any questions about this topic, or if think your workers’ compensation benefits have been prematurely discontinued or wrongly denied, we can help. The Georgia workers’ comp attorneys at the Mann Law Firm have more than 50 years of experience in representing clients. Contact us today by calling (478) 742-3381 in Macon, Dublin, Warner Robins or Milledgeville, or through our online form. We have the knowledge and the expertise to ensure that your rights are fully protected.