I developed a sickness from my job. Is this covered by workers' comp?

Potentially. Georgia law provides that an "occupational disease" is compensable so long as certain statutory requirements are satisfied. Specifically, O.C.G.A. § 34-9-280 states that an "occupational disease" means "those diseases which arise out of and in the course of the particular trade, occupation, process, or employment in which the employee is exposed to such disease." In addition, five requirements must be met: 

1. There must be a direct causal connection between the conditions under which the work is performed and the disease;
2. The disease followed as a natural incident of exposure by reason of the employment;
3. The disease is not of a character to which the employee may have had substantial exposure outside of the employment;
4. The disease is not an ordinary disease of life to which the general public is exposed; and
5. The disease must appear to have had its origin in a risk connected with the employment and to have flowed from that source as a natural consequence.

Because of these strict statutory requirements, it can be difficult to prove an occupational disease claim. If you feel that you've developed an illness because of your job, you should contact an attorney right away to discuss your options. Even if you're not in the Athens, Georgia area, feel free to contact us and we will be glad to assist you with your claim.

Quick Definitions: Independent Medical Evaluation (IME)

An Independent Medical Evaluation, or IME, is a one-time examination that can be requested by either the Employer/Insurer or the Claimant. An IME is simply a way to obtain additional evidence, or simply some evidence to support the position of either party in the workers' compensation claim. For instance, if the Claimant's authorized treating physician (ATP) gives the opinion that the Claimant's injured back is fully healed, a Claimant may want to obtain an IME to contradict the ATP's diagnosis. This evidence can come in extremely handy at a hearing or during settlement negotiations.

I disagree with my authorized physician's diagnosis. Can I get a second opinion?

If effect, yes. Under Georgia law, a Claimant is allowed to seek a second opinion with a physician of his or her choosing (in other words, it is not limited to a care provider listed on the panel of physicians) at the expense of the Employer so long as several criteria are met. This one-time second opinion is known as an Independent Medical Evaluation (IME). Again, this is a one-time evaluation--not a change in the authorized physician. Unless you seek an official change of physicians, you will continue treating with your authorized treating physician (ATP) after the IME. 

The criteria are spelled out in O.C.G.A. 34-9-202(e):

1. The injury at issue must be an "accepted compensable injury." Basically, this means that the Employer must not be disputing that the injury is covered by workers' compensation coverage.
2. The examination is being sought within 120 days of the receipt of any income benefits (either TTD, TPD, or PPD benefits).
3. The examination must take place at a reasonable time and place, within Georgia or within 50 miles of the Claimant's residence.
4. The examination must be performed by a duly qualified physician or surgeon.
5. The Claimant must give advance notice, in writing, to the Employer of the examination.
6. The examination cannot repeat any diagnostic procedures that have already been performed on the Claimant since the injury, unless the costs of the procedures which are in excess of $250.00 are paid for by a party other than the Employer or Insurer.

An IME can be an extremely valuable tool for a Claimant when negotiating a settlement. Because a Claimant only has the ability to obtain one IME, it is imperative that great care be taken when choosing the IME physician. If you are dissatisfied with the care you are receiving from your treating physician, please contact us to discuss your options.

What is the "Panel of Physicians?"

The panel of physicians is a list of medical care providers that an employer must maintain for the purpose of giving employees treatment options in the event of a work injury. This list is typically a pink-colored sheet of paper that must be posted in a “prominent place” upon the employer’s premises, such as the breakroom or next to the punch in/out clock. There are three different types of panels which may be utilized by Georgia employers, all of which must meet certain requirements in order to be deemed a “valid” panel. The following is a general outline of the basic differences in the respective panels: 

1. The “Traditional” Panel – This type of panel must have list of at least six (unless this number is not feasible in a given geographical area) unassociated medical care providers to be valid. If Doctor A and Doctor B both work in the same clinic, they are not “unassociated” for purposes of the Traditional panel. Moreover, the law does not allow for more than two “industrial clinics” to be listed on the panel, and there must be at least one orthopedist listed.
2. The “Conformed” Panel – This type of panel must have a minimum of ten unassociated medical care providers (the same definition of “unassociated” applies here). Although an employer’s utilization of a Conformed panel initially gave an injured worker different rights than the Traditional panel, the law has changed such that the only practical difference between the two panels is simply the number of care providers listed. Also, this type of panel will state “Conformed” at the top of the document serving as the panel of physicians. Thus, if the panel states that it is “Conformed” at the top of the document, but only lists six physicians, it would be deemed invalid. 
3. Managed Care Organization (MCO) – An MCO provides a much more expansive network of medical care providers than that of the Traditional and Conformed panels, and there are stricter requirements for the types of physicians that must be listed. This network of physicians is compiled by an organization with whom a self-insured employer or a workers’ compensation insurance carrier enters into a contract. Simply put, the MCO compiles a list of physicians, and then the employer or its insurer enters into a contract with the MCO which allows the employer to send its injured workers to the care providers on the list. Just like the Traditional and Conformed panels, however, the law requires that the MCO procedures be posted in a prominent place on the employer’s premises. 

It should be noted that there are requirements in addition to those mentioned above which must be adhered to by employers with respect to the panel of physicians. If any of the requirements aren’t satisfied, Georgia law states that the injured worker may then commence treatment with the doctor of his or her choosing.

If you have any questions about your workers' comp case or the panel of physicians, please let me know. Even if you're not in the Athens, Georgia area, give us a call and we will gladly help you with your case.

I was hurt at work. Can I treat with any doctor I want?

Not exactly. An injured worker must choose from one of the physicians listed on the employer’s panel of physicians (there are three kinds of panels of physicians: traditional, conformed, and MCO). Although Georgia law states that it is the injured worker’s right to choose which physician he or she would like to have designated as the authorized treating physician (ATP), this usually doesn’t happen. From my experience, it is usually the employer who chooses and sends the injured worker to one of the physicians on the panel once the injury is reported.

It’s also important to point out that if a worker is injured at a time when it is not possible to go to a panel physician (such as late at night when the clinic is closed), and the injury is serious enough to warrant immediate care, the employer will be responsible for expenses incurred as a result of the emergency care. For example, if you are injured late at night and have to go to the nearest emergency room, the employer will be responsible for the ER bill. However, this doesn’t mean that the ER physician is your ATP. At some point in the subsequent days, you will be given the option to choose a panel physician as your ATP.

Tip:  Don’t let the employer force you to treat with a doctor you don’t want to go see. It is your right to choose which physician you would like to have designated as the ATP. Having said that, if you have no preference and don’t know anything about any of the doctors, it would only serve to complicate things if you object to the physician recommended by the employer for no other reason than to assert your right to choose. In other words, don’t argue for the sake of arguing, as this could create a hostile situation between you and your employer and make your time out of work even more inconvenient than it already is. If you are dissatisfied with the care provided by your first ATP, you have the right to make a one-time change of physicians to a different doctor—but this new doctor must also be listed on the panel (unless the panel is invalid, in which case you can choose any doctor at all). You only get one chance to make a change, however, so this choice should be made very, very carefully.

Quick Definitions: "Authorized Treating Physician"

The authorized treating physician ("ATP") is an injured worker's primary doctor (usually the first doctor you go to). Every injured worker has one ATP who provides routine care and can also "arrange for any consultation, referral, and extraordinary or other specialized medical services" (like a referral to an orthopedist or neurologist). The ATP holds a lot of power over your claim, not only because he or she is providing your primary treatment and can make referrals, but also because an administrative law judge will almost always honor the ATP's opinion or decision regarding your treatment. If you're not satisfied with your treatment, however, the law does allow for a one-time change of the ATP (with certain restrictions).

Did You Know? (Lifetime Medical Care Edition)

Did you know that an injured worker is entitled to lifetime medical care as long as it relates to his or her work injury? However, this medical care can't come from just any doctor--it must come from an authorized treating physician.  Moreover, the law states that the medical care must be "reasonably required and appear likely to effect a cure, give relief, or restore the employee to suitable employment."

Tip:  Many times, an employer will try to cut an injured worker off from receiving additional care by arguing that he or she has returned to "pre-injury status"--especially if there was a pre-existing condition similar to the work injury--or that the additional care is no longer reasonable. In these situations, it's important to have an attorney to fight on your behalf to ensure that you receive proper care for your injury.

Did you know? (Panel of Physicians Edition)

Did you know that if the "Panel of Physicians" maintained by the Employer is not valid (for example, if it does not contain up-to-date information or if it does not comply with the requirements of the Georgia statute), then an injured worker "may select any physician to render service at the expense of the employer"? (O.C.G.A. ' 34-9-201).

Tip:  If you've been injured at work, always ask to have a copy of the Panel of Physicians that was posted on the date of your accident--it may come in handy if you're not satisfied with the treatment provided by the physician chosen by the Employer.