If the injured worker desires to change doctors within the posted panel of physicians, he or she may do so without approval from the Board or the insurance company. This change is only allowed one time, however. If the injured employee wants to change physicians to someone not listed on the panel of physicians, he or she must either find a doctor the insurance company will agree to, or formally request the change from State Board of Workers’ Compensation. See, O.C.G.A. 34-9-201(e). This holds true if the insurance company wants to transfer care from the established treating physician to another physician. For example, if the insurance company desires to transfer care away from Dr. Erik Bendiks to Dr. Hal Silcox, it must either convince the injured worker to agree to the change or present evidence to the State Board justifying the change. This change has tremendous impact on the claim and should not be taken lightly.
If the claim is accepted by workers’ comp and the injured employee treats with an unauthorized doctor, the cost of that treatment will not be covered by the workers’ compensation insurance carrier. However, the presiding judge may rely upon the unauthorized physician’s reports to find that the employee may be disabled or entitled to benefits. Georgia Baptist Medical Center v. Moore, 219 App. 171 (1995). Conversely, the judge may also rely on the unauthorized doctor’s reports to deny the claim.
If the injured worker’s claim is denied or “controverted”, the injured employee can seek treatment with whomever he chooses. Board Rule 201(b). However, this treatment will not be paid for by the insurance company unless the State Board orders payment or the insurance company voluntarily pays. Generally, this issue will come before the State Board and the claimant will bear the burden of demonstrating that the injury arose out of and in the course of his or her employment. If the injured employee is successful, the costs for the treatment incurred will likely be covered by the presiding judge’s award.