Can I get a referral in a workers’ compensation claim?
In many cases the “company doctor” may not have the expertise to adequately treat the injured worker. Therefore, a “referral” may be made to another physician or specialist. For example, an injured employee may treat initially at the Spring Street Concentra Medical Center. These doctors are generally “occupational medicine” physicians who will refer to, or consult with, orthopaedics, neurologists, or other specialty doctors who will treat injured workers. In most cases, the Concentra doctors may refer to another physician at Peachtree Orthopedic or Resurgens Orthopaedics.
Do I then need pre-certification?
Interestingly, the term “referral” is not defined in Georgia Workers’ Compensation law. However, it does allow for these referrals and consultations at the Employer/Insurer’s expense provided the claim has been accepted. The code states that the authorized treating physician “may arrange for any consultation, referral, and extraordinary or other specialized medical services as the nature or the injury shall require without prior authorization from the Board.” See, O.C.G.A. 34-9- 201 (b). Insurance companies, however, are reluctant to pay for these referrals and often require “pre-certifications”. Unfortunately, these pre-certification procedures generally delay treatment to the injured worker. In many cases, the insurance companies must be compelled by the State Board.
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