10 Ways Authorized Treating Physicians Mess Up Your Georgia Workers’ Comp Claim
As much as we want to believe all doctors follow the “do no harm” code of ethics, workers’ compensation claims prove that some authorized treating physicians mess up or prioritize their own needs over their patients’.
I’m not going to lie – it hurts just to write that.
Sadly, it’s true. There are a good number of doctors who work with workers’ compensation insurance companies.
Unfortunately, some are more focused on getting their cut from the insurance company than they are on helping heal work injuries.
These authorized treating physicians do all they can to get you back to work sooner so the insurance company doesn’t have to pay as much for your care, which puts them in the insurance company’s good graces.
Here’s the good news – you get a say in which doctor treats you following a workplace injury.
If you let your employer choose a doctor for you, you may wind up being treated by a very employer-friendly doctor (and not a patient-friendly one).
Your employer should have posted a valid panel (list) of physicians. While you must see one of the doctors on this list, you get to choose which one.
If your employer did not have a valid, posted panel of physicians in place on the date of your accident, you and your lawyer get to pick ANY doctor you want to be your authorized treating physician ‒ and the insurance company has to pay for it.
Even if you choose an ethical doctor, authorized treating physicians mess up from time to time when dealing with workers’ compensation claims – especially if they are not a doctor who deals with workers’ compensation very often.
Keep reading for 10 ways authorized treating physicians mess up Georgia workers’ compensation claims.
1. Fall for an “Out of Network” Excuse
Recently, an insurance adjuster got a doctor’s office to change a referral by claiming the referral was “out of network.”
This is a mistake. Authorized treating physicians mess up here because they’re so used to group health insurance networks. But, for workers’ compensation purposes, “networks” are irrelevant.
If a doctor says my client needs to have physical therapy at a specific location, that’s it.
It needs to be authorized there, and whether they’re “in network” with the workers’ compensation insurance company or not is completely irrelevant.
Authorized treating physicians are the captains of the medical ship. What they say goes, and they should not worry about whether their recommendations get authorized. If the recommendations don’t get authorized, that’s where I step in and make sure they get authorized.
Luckily, in my recent example, I was able to get a judge to force the other side to authorize the referral.
2. Work on Insurance Panels
Unfortunately, if physicians are on insurance panels, then adjusters threaten them with removal from their panels.
Many of these authorized treating physicians will fall in line and do what the adjusters want them to do rather than what is best for the patient.
3. Referrals That Hurt More Than Help
Another way authorized treating physicians mess up is by giving general referrals.
General referrals can be the devil.
Let’s say the physician writes a general referral, as in, “Referral to Neurologist.” This opens the door for the insurance company to pick the doctor – and they could pick someone horrible.
In contrast, specific referrals rule the day.
If you want the authorized treating physician to refer to a doctor you like, get that referral in writing. Then, the insurance company has to authorize it.
4. Push Certain Pharmacies
You can pick your own pharmacy – even choosing an online pharmacy that caters to injured workers.
Insurance companies hate this and try to argue that you can’t do this, but they are wrong.
Most times, insurance companies want to try to force you to use their budget pharmacies or companies with which they have contracts.
They try to make you use a card they send you, but no, you can use CVS, Walmart, Injured Workers Pharmacy (IWP), etc.
You can decide where to get your prescriptions filled.
5. Lie to Protect Insurance Companies
As mentioned earlier, there are some not-so-nice doctors who are really in it for themselves.
Their goal is to make money – not to heal you.
They want to stay on good terms with insurance companies, so they lie about the extent of your workplace injuries.
6. Misdiagnose Your Condition
Unfortunately, one of the more common ways authorized treating physicians mess up is by misdiagnosing your condition.
The key to receiving the workers’ compensation benefits you deserve comes down to your physician’s diagnosis.
For example, the authorized treating physician is the one who determines your work restrictions and if you are entitled to Temporary Total Disability (TTD), Temporary Partial Disability (TPD), or Permanent Partial Disability (PPD).
If the doctor misdiagnoses your condition, it will significantly hinder your workers’ compensation benefits and overall healing.
Fortunately, you are entitled to a second opinion.
7. Don’t Believe Workers’ Injury Claims
There are some people who try to get workers’ compensation benefits when they have not actually been injured at work.
As a result, some doctors are suspicious when injured workers come in for examinations. These doctors may be predisposed to think employees aren’t being truthful about their injuries.
These physicians may label the patient as a malingerer – someone who pretends or exaggerates incapacity or illness (as to avoid duty or work), according to Merriam-Webster Dictionary.
This is why it is so important to be honest and upfront about how your injury happened and how you are feeling when you speak to your authorized treating physician.
8. Encourage You to Speak to a Nurse Case Manager
A nurse case manager (NCM) is a licensed professional hired by the insurance company to save money on your claim.
Nurse case managers will often try to weasel their way into the examination room with you and the physician.
Sometimes authorized treating physicians mess up by encouraging patients to allow nurse case managers into the examination room, or physicians agree to meet privately with the nurse case manager after your appointment. Super sketchy!
This is a problem because it gives them access to your private conversation with your doctor.
If your doctor asks you to describe your pain and you say something like, “Well, I’m sure I’ll be okay…” the nurse case manager will turn around and tell the insurance company what you said, and they will argue you don’t deserve benefits because “you’ll be okay.”
[Related Read: Do I Have to Talk to My Nurse Case Manager In Georgia?]
9. Avoid Recommending Expensive Tests or Therapeutic Services
Physicians who work with workers’ compensation insurance companies are very aware that these companies do not want to pay money – especially not a lot of money.
Therefore, some physicians avoid recommending expensive tests, such as MRIs or CT scans.
Similarly, some physicians push pain medications rather than lengthy physical rehabilitation because it is cheaper for insurance companies.
Some physicians want to stay on good terms with insurance companies to continue to receive patient referrals, and this is one way to do so.
10. Fail to Keep Accurate Records
Your authorized treating physician’s records will be used extensively during your workers’ compensation claim.
Therefore, it is critical for physicians to clearly document everything.
Authorized treating physicians mess up when they fail to document the extent of your injury, the recommended treatment plan, and your recovery status.
Work with an Experienced Workers’ Comp Attorney to Ensure Quality Care
It is wise to hire a qualified workers’ compensation attorney to help you navigate the complexities of a work injury.
With ample experience working with authorized treating physicians in Georgia, DeMedeiros Injury Law knows who will fight for you and who will fight against you.
Watch this YouTube video to see 5 more reasons why you should hire a Work Comp Lawyer.