With any injury or illness, it is common for a primary treating physician to find it necessary to refer the patient to another doctor for specialized care. Obviously, in a workers’ compensation setting, this is also possible. The question then arises, how does the Workers’ Compensation Act provide for such referrals?
O.C.G.A. § 34-9-201(b)(1) provides:
The physician 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 this subsection shall not be permitted to arrange for any additional referrals.
As the statute clearly reads, an authorized treating physician can make a referral for specialized care to any other physician. This is not limited to the posted panel of physicians. The only limitation is that the physician to whom the injured worker is referred may not then make another referral. Rather, that physician must consult with the authorized treating physician for any further referrals.
The question then arises – can the employer refuse to authorize treatment from a physician who is referred by the authorized treating physician? The short answer is generally not. Should the employer fail to authorize treatment from the referred physician, that would certainly draw a hearing request from the claimant’s attorney. The employer, then, would have the burden of showing that the treatment was not necessary. Presumably, this would require opinions of other physicians to combat the referral. Absent any such evidence, it would likely be deemed unreasonable for the employer to refuse to authorize such treatment thereby subjecting themselves to assessments of attorney’s fees.