Employee Selects from Panel
For all injuries occurring on or before June 30, 2013, and for injuries occurring on or after July 1, 2013, designated as catastrophic injuries pursuant to subsection (g) of Code Section 34-9-200.1, the employer shall furnish the employee entitled to benefits under this chapter such medical, surgical, and hospital care and other treatment, items, and services which are prescribed by a licensed physician, including medical and surgical supplies, artificial members, and prosthetic devices and aids damaged or destroyed in a compensable accident, which in the judgment of the State Board of Workers' Compensation shall be reasonably required and appear likely to effect a cure, give relief, or restore the employee to suitable employment.
(2) For all injuries occurring on or after July 1, 2013, that are not designated as catastrophic injuries pursuant to subsection (g) of Code Section 34-9-200.1, the employer shall, for a maximum of 400 weeks from the date of injury, furnish the employee entitled to benefits under this chapter such medical, surgical, and hospital care and other treatment, items, and services which are prescribed by a licensed physician, including medical and surgical supplies, artificial members, and prosthetic devices and aids damaged or destroyed in a compensable accident, which in the judgment of the State Board of Workers' Compensation shall be reasonably required and appear likely to effect a cure, give relief, or restore the employee to suitable employment. (O.C.G.A. § 34-9-200(a))
Change of Provider
If the employer posts a traditional Panel of Physicians: The employee may make one change from one physician to another on the same panel without prior authorization of the board. (O.C.G.A. § 34-9-201(b)(1))
A traditional posted Panel of Physicians shall consist of at least 6 physicians or professional associations or corporations of physicians who are reasonably accessible to the employees, but is not limited to the minimum of 6. However, should a physician on the panel of physicians refuse to provide treatment to an employee who previously has received treatment from another panel physician, the employer/insurer, as soon as practicable, shall increase the panel for that employee by one physician for each such refusal. The Board may grant exceptions to the required size of the panel where it is demonstrated that more than 4 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 minimum panel shall include an orthopedic physician, and no more than 2 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 (O.C.G.A. § 34-9-201.(b) (1), O.C.G.A. Title 34 Appx. Bd. Work. Comp. r. 201. Panel of Physicians).
State Mandated forms to be used for panels:
GA Panel of Physicians Form WC-P1:
GA Conformed Panel of Physicians Form WC-P2:
In previous discussions with GA regulators, the state has advised that state-mandated panel forms cannot be altered in any way without permission from the Executive Director of the GA BWC. Additionally, Hospitals should not be included on any provider panel. If more than the required number of providers is included on a panel, a separate sheet may be utilized. The sheet should be a blank piece of paper that includes the additional providers. It is acceptable to include a statement indicating that the sheet is an additional page accompanying the WC-P1 (or appropriate form number) form.
Georgia law does not define 'Industrial Clinic', however the state has advised that any walk-in clinic that routinely treats work injuries may be considered an industrial clinic, while a specific doctor's office where appointments are necessary is not going to be considered an industrial clinic.
Employee Selects from Network
A self-insured employer or the workers' compensation insurer of an employer may contract with a managed care organization certified pursuant to Code Section 34-9-208 for medical services required by this chapter to be provided to injured employees. Medical services provided under this paragraph shall be known as "Managed Care Organization Procedures." Those employees who are subject to the contract shall receive medical services in the manner prescribed in the contract. Each such contract shall comply with the certification standards provided in Code Section 34-9-208. Self-insured employers or workers' compensation insurers who contract with a managed care organization for medical services shall give notice to the employees of the eligible medical service providers and such other information regarding the contract and manner of receiving medical services as the board may prescribe. (O.C.G.A. § 34-9-201(b)(2))
The WC/MCO must include procedures to insure that employees will receive services in accordance with the following criteria:
The medical case manager shall inform the employee of his right to choose from the providers designated in Rule 208(a)(1)(E), inform the employee that a list of medical providers is available and provide assistance in obtaining the list if necessary. The medical case manager shall assist the employee in choosing a provider appropriate to the injury. The physician so chosen shall be deemed the "authorized treating physician" for all purposes under the Workers' Compensation Act. (O.C.G.A. Title 34 Appx. Bd. Work. Comp. r. 208 (2009) §208. MCO Rules (a)(1)(K))
Change of Provider
Employees must be allowed to change authorized treating physicians within the managed care plan at least once without proceeding through the managed care plan's dispute resolution process. In such cases, employees shall give notice to the managed care plan for a change in their authorized treating physician. (O.C.G.A. Title 34 Appx. Bd. Work. Comp. r. 208 (a)1(K))
In previous discussions with GA regulators, that state has advised that when an employee is injured, the MCO must provide a list of all providers available in the employer's geographic location. A case manager may help identify the specialty appropriate to the injury, then provide a list of all providers of that specialty in the employer's geographic area from which the employee chooses.
A state-mandated MCO posting is available.
The information on this website constitutes summary information only and does not constitute legal advice. Review of the full text of the referenced statutes and regulations may be necessary. Coventry Health Care Workers' Compensation, Inc. makes no representations or warranties about the accuracy of the information contained on this website.