WHAT IF THE WORKERS’ COMPENSATION DOCTOR SAYS I HAVE ARTHRITIS AND ITS NOT FROM AN ACCIDENT AT WORK?

Hi, it’s Bernard Nomberg with the Nomberg Law Firm in Birmingham. Wanted to spend a minute or two talking with you about authorized treating physicians and medical care in Alabama worker’s compensation cases.

The way that the laws in Alabama are designed that if a case is compensable, meaning that they worker’s comp insurance carrier for the employer is going to cover the medical care and related costs, et cetera in a claim, they have the right to a large extent to control medical care and the direction it heads into.

Now, that doesn’t mean that the injured worker doesn’t have choices and options and make their own decisions, but if the insurance carrier’s going to pay for that medical care, they have the right to authorize who that carrier is, and to a certain extent, what that medical care is going to be.

And we don’t have time to discuss all of the ins and outs about how this works, but what I wanted to really stress was what happens in that situation where the authorized medical care provider has a certain opinion about medical situation with an injured worker, but the injured worker doesn’t think that that’s correct or that should go that way.

Well, if there becomes a conflict there, and the injured worker doesn’t want to stay with that same authorized doctor, if they haven’t already used their panel of four choice, we can make that request of the adjuster. Or the injured worker always has the option to go to his or her own doctor, which they would financially responsible for paying, and the work comp carrier does not have to honor it or pay for it. That would have to come through a court order for them to pay for that.

But let me give you a real case example. Let’s say that somebody has injured their knee in a witnessed accident at work, and they go to what we call the gateway doctor. That’s the plant doctor or the occupational medicine doctor who takes a look at it and says, “This is out of my specialty. You’ve got some kind of injury here. I want to send you to a specialist.” And then they refer the injured worker to an orthopedist who specializes in knees. Scans are done. MRIs, X-rays, what have you, and then the authorized treating knee doctor says, “Well, you’ve got arthritis here, and I think that’s really your issue.”

But in that scenario, the injured worker says, “Well, I’ve never had any problems before this event, this accident. I never knew I had arthritis. Never had any problems, no limitations, restrictions.” But the authorized treating knee doctor says, “This is arthritis. This is not from this accident.”

Well therein lies the problem. Effectively, the authorized treating doctor has curtailed the medical care. The injured worker’s still hurt, still needs medical care, and still believes that it was from work. Well in that scenario, they may be able to ask for a panel of four or go to their own doctor, but they would be responsible for financially.

Now that’s just one very small example. There’s hundreds of different types of examples to share that we’ve dealt with. If you have issues with this, and this is a very, very common problem and concern and stressful time for injured workers, please consider giving us a call. We can help deal with this. We do it every day. 205-930-6900 is our office number. Nomberglaw.com on the web, and we have Facebook and Twitter, as well. Thanks.

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