Do Georgia Workers’ Compensation Recipients Need To Obtain Pre-Authorization for All Medical Procedures?

Georgia workers’ compensation claimants may occasionally receive treatment or tests that are not pre-authorized to receive workers’ compensation benefits. In a recent opinion, this issue was discussed at length by a state appellate court.

The Facts of the Case

According to the court’s opinion, the claimant suffered a neck injury while at work, which was covered under workers’ compensation. Although the claimant had preexisting neck injuries, the claimant received workers’ compensation benefits to treat his neck pain.

An orthopedic surgeon evaluated the claimant’s neck and recommended cervical fusion surgery. The claimant filed a claim to have the operation covered under workers’ compensation. The employer then had an independent medical examiner evaluate the case, who found that the work injury was not the major contributing cause of any condition for which the fusion surgery was recommended, and the employer denied the claim.

The appeals court found that the workers’ compensation judge correctly decided that the claimant’s neck condition, including preexisting injuries, was compensable because the employer treated the preexisting injuries initially and failed to timely raise that issue. However, the claimant had another unauthorized surgery before the workers’ compensation issue was resolved. The appeals court explained that the claimant had to prove that the unauthorized surgery was compensable, reasonable, and medically necessary, and that claimant did not present any medical testimony concerning the cause and medical necessity of this surgery. Therefore, the court reversed the order providing compensation for the unauthorized surgery.

Authorization of Medical Treatment under the Georgia Workers’ Compensation Act

Under Georgia’s Workers’ Compensation Act, an employee covered under the Act has the right to medical care related to his work injuries, which includes “medical, surgical, and hospital care and other treatment, items, and services which are prescribed by a licensed physician . . . 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.”

Medical treatment is usually provided by an authorized treating physician, which the employer has the right to designate to a certain extent. The treating physician can arrange for consultations or other specialized services without prior authorization, but some tests and treatment may also require pre-authorization. Under Georgia Workers’ Compensation law, medical treatment and tests prescribed by the treating physician should be paid by the employer as long as they are related to the on-the-job injury, and are either 1.) reasonably required and appear likely to either effect a cure, 2.) provide relief, 3.) restore the employee to suitable employment, or 4.) establish whether the employee’s condition is causally related to the work injury.

Atlanta Workers’ Compensation Lawyers

If you have been injured on the job, you may be entitled to Georgia workers’ compensation benefits. The workers’ compensation system can be difficult to navigate, and a successful workers’ compensation claim requires an ability to articulate your claim and your expenses clearly. The law office of J. Franklin Burns, P.C. has decades of experience handling all types of Georgia workers’ compensation claims. Our law firm offers our clients quality legal representation and responsive client service. To learn more, contact our law firm for a free consultation and case evaluation at 404-303-7770 or through our online form.

More Blog Entries:

Is a Police Officer Working at a Georgia Grocery Store an “Employee” of the Store?, December 17, 2018, Atlanta Workers’ Compensation Lawyer Blog

Appealing a Georgia Workers’ Compensation Case, September 13, 2018, Atlanta Workers’ Compensation Lawyer Blog