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Workers Comp: Court Addresses Panel Of Four Misuse

Blackwell Law Firm -- Alabama Personal Injury LawyersWhat is a panel of four? How can it impact your Alabama work comp case? Why am I discussing the issue now? Medical treatment is an important issue to injured Alabama workers. We answer questions for callers on this issue almost every day at our office. Since the Alabama Court of Civil Appeals recently discussed the issue, I thought it was a good time for me to do so as well.

When you suffer a serious work-related accident, a lot of worries come to mind. Will I receive good medical care? Will I heal and recover? Will I be able to continue working? Our work comp system was created to provide medical and disability benefits. If you suffer a work-related accident, you are entitled to medical treatment. Your employer (through its insurer) is obligated to provide treatment. It should be simple. But, too often it’s not. Too often, employers and their insurance companies delay, deny, or just ignore medical care. When they do, you suffer.

WHO PICKS THE FIRST DOCTOR?

How do I start receiving medical care under work comp? In Alabama, the employer gets to pick the initial doctor. In many places, like Huntsville, this often means a local clinic such as Occupational Health Group (OHG). These local occupational clinics often serve as the initial employer-chosen doctor. I have a lot of thoughts on these “gatekeeper” clinics. That’s what I call them, gatekeepers. After handling work comp cases for more than two decades, I’ve seen their practices. But, that’s a topic for another day.

Alabama law allows your employer to pick the doctor. When your employer chooses a local occupational doctor, that physician will then refer you for needed specialty care. Let’s take a typical work-related shoulder injury as an example. You lift something heavy at work and you feel a sudden “pop” in your shoulder. You are hurting. You report the accident. Your employer sends you to OHG. The OHG physician will probably drug test you. Then, the OHG physician will examine you. Yes, I’ve heard plenty of stories about what passes for an “examination.” The doctor may start with conservative care, like physical therapy. At some point, he or she may refer you to a local orthopedic for specialty care. I counsel people every week who are at this stage of care — They need a referral to an orthopedic but the OHG doctor is delaying. It’s usually an issue of cost — The insurance company is trying to save money at the cost of your health. I have a lot of advice for injured workers dealing with a gatekeeper doctor. That is also a topic for another day.

WHAT IF I AM NOT HAPPY WITH THE COMPANY DOCTOR?

This is a frequent question. If you are not happy with your doctor, Alabama law allows you to request what is called a “panel of four.” Alabama law requires the employer (through its insurer) to provide you with a panel of four physicians from which you must choose a new doctor. A panel of four is an important issue and choosing the right doctor from the four is a serious decision. With a few exceptions, Alabama law only allows you to exercise this right one time. In other words, you probably cannot come back and ask for another panel if unhappy with your next doctor. So, make your request and choice, wisely. Do NOT make the request at all unless really needed. If you need a specialist, wait and see whether you get a good one before wasting a panel request.

HOW DO INSURANCE COMPANIES TRY TO REMOVE MY OPTIONS?

Insurance companies frequently play games with their panel of four doctors. The games are designed to remove patient choice and avoid treatment costs. They do NOT want you choosing a doctor. What type of games do insurance companies play?

Insurance companies frequently include the names of doctors who are retired, who don’t treat your specific injury, or who will not accept you as a patient. Sometimes, they include the names of doctors with very distant practices. It’s all an effort to limit your choices. Don’t fall for it. If you request a panel, insist it be a legitimate one with doctors ready and able to treat your specific injury. And, consult an experienced work comp attorney. Through the years, I’ve read records and taken depositions of most area specialists. We have some very skilled medical specialists around both Huntsville and Birmingham. In my two decades of experience, I’ve learned which ones have good track records for helping their patients. Seek advice to pick the right doctor. You may not get a second chance!

One game played by a local Huntsville company — Provide a panel when not requested. Go back to my earlier example of a shoulder injury. You are sent to OHG for an initial doctor. That doctor eventually decides to send you to an orthopedic specialist. Rather than provide you an orthopedic, the work comp carrier sends you a panel and tells you to choose one. Hang on! You did not ask for a panel. Instead, the OHG doctor referred you to an orthopedic specialist. The comp carrier must authorize an orthopedic to treat you. The insurance carrier should have simply authorized a local orthopedic surgeon to treat you.

What’s the big deal? By providing you a panel BEFORE authorizing an orthopedic, the comp carrier has required you to exercise your only right to switch doctors. What if you are not happy with the chosen doctor? Too bad. Instead, the comp carrier should have provided you an authorized orthopedic. And, you would still have your right to a later panel if not happy with that chosen orthopedic.

In the case of Ex parte Kohler Company, Inc., the Alabama Court of Civil Appeals recently addressed this situation. What happened? The employer hurt her ankle at work. Kohler sent her to OHG. At some point, the OHG doctor referred her for specialized care with an orthopedic surgeon. Yet, Kohler did not arrange for the worker to see an orthopedic. Instead, the adjuster provided a panel of four after speaking with the injured worker on the phone. The worker chose an orthopedic but was unhappy with him. When she sought a new doctor, the employer argued she had already been provided a panel of four physicians. Kohler argued the injured worker had no more rights.

Thankfully, the court understood Kohler had failed its duty to authorize an orthopedic. Kohler should have authorized a doctor rather than requiring the worker to exhaust her one safety option for a new physician. As the court noted, panels of four are intended for workers who are not happy with the authorized doctor. They were certainly not intended as a means of authorizing an initial specialist.

I don’t know the lawyer who handled this recent case. Over the last 20 years, I’ve had several Huntsville work comp cases against this employer. I’ve refused their premature panels on several occasions and required them to authorize a doctor. So, I don’t believe their “mistake” was innocent. I believe it was part of a practice designed to narrow the worker’s health care and rehabilitation.

If you are seriously hurt at work, the insurance companies know many tricks to delay or deny medical care. Many of these tricks involve choosing and authorizing physicians. You can easily make a decision that allows your treatment to be compromised. Seek expert advice before making a choice.

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From its office in Huntsville, the Blackwell Law Firm helps personal injury victims across Alabama. We are happy to answer your questions. Consultations are always free and confidential.

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