One-Times . . .They Are A-Changin’: A Look at Hawkins and the Right to a One-Time Change of Physician
Meet Mel Ingers. Mel stepped on a cashew while working at the grocery store and sustained a contusion to his right knee. Mel opted to treat with Dr. Ima Overitt from the grocery store’s posted panel. After extensive treatment and testing, Dr. Overitt opined Mel’s injury had resolved and he did not require additional treatment related to the cashew calamity. The next day, Mel asked to transfer his care to Dr. Rick Stricksons. Mel’s attorney reached out to the defense counsel asking to schedule with Dr. Stricksons, but the grocer and their insurer did not want to authorize further medical treatment. The ability to transfer care to another panel physician is established by O.C.G.A. § 34-9-201(b)(1), stating in part, “The employee may make one change from one physician to another on the same panel without prior authorization of the board[.]” Generally, in a compensable claim such as Mel’s, the claimant would have the right to avail himself of a one-time change to a doctor from the panel of physicians. However, in this case the claimant’s authorized treating physician (ATP), Dr. Overitt, stated the claimant did not require further medical treatment. As such, the employer and insurer did not want to pay for additional medical treatment in the form of authorizing a new change of physician. Can they defend against what would normally be a statutory right? In a situation where the parties do not agree to a change of physician, the claimant can file a hearing request seeking a change of physician. This type of hearing request is more commonly seen where a claimant has already exercised his or her one-time change and is requesting an additional change of physician, over and beyond the statutory right, or if there is a dispute over the validity of the panel and the claimant wants to begin treatment with a non-panel physician. However, a recent decision from the Georgia Court of Appeals stands for the position that a claimant may not always be able to avail himself of the statutory one-time change if the court finds the claimant does not require further medical treatment. The Hartford Casualty Insurance Company et al. v. Hawkins, 353 Ga.App. 681 (2020).
In Hawkins, the employer and their insurers appealed a Superior Court order overturning a decision from the State Board’s Appellate Division which denied, among other things, the claimant’s request for a change of ATP. The Board found that Hawkins’ work-related injuries had resolved prior to her request for a change of her ATP and denied the request, as well as her request for additional medical treatment for her work-related injuries. The Georgia Court of Appeals held the Superior Court erred in concluding Hawkins was entitled to a change of ATP.
In clarifying its determination, the court held the claimant had the burden of proving the medical services she was seeking were directly related to a work injury, and since the Board’s finding that the work-related injuries had resolved was based on evidence in the record, it acted within its discretion when denying the request for additional medical treatment. As the request for additional medical treatment in general was denied, the court reasoned, the change of ATP issue was moot, and the Superior Court erred in determining Hawkins was entitled to a change of her ATP.
In practical terms, there now exists authority upon which to reasonably deny a request to change ATPs when such request comes after the current ATP has determined the injury is fully resolved. However, as a note of caution: the ATP’s opinion, though generally given deference by the administrative law judge (ALJ) and the Board, is not the final word on the matter. The court must agree the claimant also requires no further treatment, in order to reach the holding in Hawkins.
In the cashew contusion case, the employer’s workers’ compensation attorneys at Swift Currie got in-touch with Mel Ingers’ counsel to let him know they were denying the request based on Dr. Overrit’s determination the injury had fully resolved. Mr. Ingers has since filed a hearing request seeking an order granting his request. If the employer/insurer can successfully convince the ALJ the claimant does not require further medical treatment, the claimant’s request for his one-time change to Dr. Strickson may be a non-starter.
Attorney Contact Info