2025 Code of Georgia
Title 34 - Labor and Industrial Relations (Chs. 1 — 15)
Appendix A - Rules and Regulations of the State Board of Workers’ Compensation
Rule 201 - Panel of Physicians
(a) The employer may satisfy the requirements for furnishing medical care under O. C. G. A. § 34-9-200 in one of the following manners:
(1)
(i) A traditional posted panel of physicians shall consist of at least six physicians or profession associations or corporations of physicians who are reasonably accessible to the employees but is not limited to the minimum of six. However, should a physician on the panel of physicians refuse to provide treatment to an employee who previously has received treatment from an associated panel physician, the employer/insurer, as soon as practicable, shall increase the panel for that employee by one physician for each such refusal. The Board may grant exceptions to the required size of the panel where it is demonstrated that more than four physicians or groups of physicians are not reasonably accessible. The physicians selected under this subsection from the panel may arrange for any consultation, referral, and extraordinary or other specialized medical services as the nature of the injury shall require without prior authorization from the Board; provided, however, that any medical practitioner providing services as arranged by a primary authorized treating physician under O. C. G. A. § 34-9-201(b)(1) shall not be permitted to arrange for any additional referrals. The minimum panel shall include an orthopedic physician, and no more than two physicians shall be from industrial clinics. Further, this panel shall include one minority physician. The minority physician so selected must practice within the State of Georgia or be reasonably accessible to the employee’s residence. “Minority” shall be defined as a group which has been subjected to prejudice based on race, color, sex, handicap or national origin, including, but not limited to Black Americans, Hispanic Americans, Native Americans or Asian Americans. Failure to include one minority physician on the panel does not necessarily render the panel invalid. The Board reserves the right to allow exceptions when warranted. The employee may make one change from one physician to another on the same panel without prior authorization of the Board. The party which challenges the validity of a panel shall have the burden of proving that the panel violates the provisions of O. C. G. A. § 34-9-201 and Board Rule 201.
(ii) In the event that the Board has granted any exceptions to the panel requirements, all exceptions must be posted at the same location as the panel.
(iii) In addition to posting of the panel of physicians upon the business premises, “posting” of the Panel of Physicians (WC-P1) pursuant to O. C. G. A. § 34-9-201(c) and the Bill of Rights (WC-BOR) pursuant to Rule 81.1 may include electronic publication of the information via on-line access. When posting via electronic publication, the employer shall provide a website or free application with access instructions to the employee. In the event the employee has no internet access, the employer shall provide the employee with access to the panel. On-line posting shall not eliminate the requirement of posting the panel of physicians on the business premises of the employer.
(2) An employer or the workers’ compensation insurer of an employer may contract with a workers’ compensation managed care organization certified pursuant to O. C. G. A. § 34-9-208 and Board Rule 208. A “workers’ compensation managed care organization” (hereinafter “WC/MCO”) means a plan certified by the Board that provides for the delivery and management of treatment to injured employees under the Georgia Workers’ Compensation Act. The party which challenges the validity of the WC/MCO panel shall have the burden of proving that the panel violates the provisions herein. An employer utilizing a WC/MCO may satisfy the notice requirements of O. C. G. A. § 34-9-201(c) by posting a notice in prominent places upon the business premises which includes the following information:
(A) The employer has enrolled with the specified WC/MCO to provide all necessary medical treatment for workers’ compensation injuries. An employee with an injury prior to enrollment may continue to receive treatment from the non-participating authorized treating physician until the employee elects to utilize the WC/MCO;
(B) The effective date of the WC/MCO;
(C) The geographical service area (by counties);
(D) The telephone number and address of the administrator for the employer and/or WC/MCO who can answer questions about the managed care plan;
(E) How the employee can access care with the WC/MCO and the toll-free 24-hour telephone number of the managed care plan that informs employees of available services.
(b) The employer/insurer cannot restrict treatment of the employee to the panel of physicians or WC/MCO when the claim has been controverted. However, if the controverted claim is subsequently found to be or is accepted as compensable, the employee is authorized to select one of the physicians who has provided treatment for the work-related injury prior to the finding or acceptance of compensability, and after notice has been given to the employer, that physician so selected becomes the authorized treating physician. The employee may thereafter make one change from that physician to another physician without approval of the employer and without an order of the Board. However, any further change of physician or treatment must be in accordance with O. C. G. A. § 34-9-200 and Board Rule 200.
(c) When a case has not been controverted but the employer fails to provide any of the procedures for selection of physicians as set forth in O. C. G. A. § 34-9-201(c), the employee is authorized to select a physician who is not listed on the employer’s posted panel of physicians or WC/MCO. After notice has been given to the employer, that physician so selected becomes the authorized treating physician, and the employee may make one change from that physician to another physician without approval of the employer and without an order of the Board. However, any further change of physician or treatment must be in accordance with O. C. G. A. § 34-9-200 and Board Rule 200.
(d) A party requesting a change of physician must do so in the manner prescribed by Board Rule 200.
Annotations
Notes
Note as to revisions.The revision effective July 1, 1996, added language at the end of the first sentence in paragraph (1) of subsection (a).
The revision effective July 1, 1997, rewrote subsection (b).
The revision effective July 1, 1998, in subsection (a), inserted “The employee may make one change from one physician to another on the same panel without prior authorization of the board.” near the end of paragraph (1), and substituted “of the board” for “within sixty days of the date of first treatment for the injury” at the end of the fourth sentence of paragraph (2).
The revision effective July 1, 2001, in subsection (a), changed the paragraph designation to division designation, inserted “Until December 31, 2001,” to the beginning of division (1)(i) and added division (1)(ii).
The revision effective July 1, 2002, in subparagraph (a)(1)(i), deleted “Until December 31, 2001” and substituted “six” for “four” twice in the first sentence, added the second sentence, and deleted “All exceptions must be posted at the same location as the panel.” near the end, and rewrote subparagraph (a)(1)(ii); and substituted “ O.C.G.A. § 34-9-20(c)” for “ O.C.G.A. § 34-9-20(a)”.
The revision effective July 1, 2015, rewrote subparagraph (a)(1)(i), deleted paragraph (a)(2), redesignated former (a)(3) as present paragraph (a)(2), and deleted “, conformed panel of physicians,” following “panel of physicians” in the first sentences of subsections (b) and (c).
The revision effective September 1, 2019, substituted “an associated panel physician” for “another panel physician” in the second sentence in subparagraph (a)(1)(i), and added subparagraph (a)(1)(iii).
JUDICIAL DECISIONS
Charges for treatment. —When employee sought and received treatment before filing a claim for benefits and thus before employer and its insurer had an opportunity to controvert the claim, subdivision (b) of this Rule will not be construed to prevent them from denying responsibility for charges for the treatments thereby subverting the intent and meaning of O.C.G.A. § 34-9-201. Ledbetter v. Pine Knoll Nursing Home, 180 Ga. App. 654, 350 S.E.2d 299, 1986 Ga. App. LEXIS 2244 (1986).
