Georgia court eyes 'authorized physician' term in workers' comp claims
'If you don't have the authorized treating physician's report releasing the person to full duty, then it's like a crapshoot,' Presiding Judge M. Yvette Miller said.
Swift Currie attorney Tim Lemke approached the Georgia Court of Appeals on behalf of the city of Atlanta to clarify administrative rule construction in the state Workers’ Compensation Act.
The issue at hand is what doctors have the authority to issue work releases for employees and whether an existing authorized treating physician can confer that title and authority onto a referral doctor. The devil is in the details — specifically whether the phrase “employees’ authorized treating physician” should be read with the article “an” or “the” in front of it. That is, are there one or multiple authorized treating physicians?
“It matters immensely to workers’ compensation and to the system that operates around workers’ compensation because treating physicians are that important to the system,” Lemke said.
Indeed, many eyes were on the case, including Presiding Judge M. Yvette Miller, who took interest because of her background in worker’s compensation, and the Georgia Legal Foundation, which filed an amicus brief in support of the court’s consideration.
At the heart of the dispute is an Atlanta police officer who sought the opinions of two doctors, an authorized treating physician and an authorized referral physician, regarding an injury and was given light-duty work status. However, the defendant-appellants requested a third physician’s opinion, which recommended a full-duty release. This resulted in the suspension of the officer’s indemnity benefits.
According to Miller, “The authorized treating physician is really the only person in the comp that can give you a full duty release and you as the employer can then feel confident that when you file a WC-14 [form] and attach the medical report of the authorized treating physician, then you can cut off benefits. If you don’t have the authorized treating physician’s report releasing the person to full duty, then it’s like a crapshoot.”
Lemke, on the other hand, contends that “the only power they have different from another doctor is they can make additional referrals.” Defendant-appellants illustrated a hypothetical where, rather than serving the role of gatekeeper, instead having a single authorized treating physician creates an issue where, if a worker had injuries to multiple parts of the body, the doctor could sign off on them returning to work without a holistic analysis of their health.
“Under our analysis, when you have multiple body parts, you need a full-duty release from each of those providers to protect the employee and to accurately suspend benefits,” Lemke said.
“That’s not totally correct,” Miller replied.
Plaintiff-appellee counsel, Kyle Johnston, shared Miller’s view in this respect.
“I’ve been doing this for 15 years, and I have yet to encounter a situation where the authorized physician makes referrals to specialists, which happens all the time, but where the authorized, treated physician doesn’t defer to those doctors with respect to those specialties. That’s the whole reason why they make the referral — because it is specialized care,” Johnston said.
If Lemke’s hypothetical did happen, Johnston said he would file a motion pointing out his client was still under restrictions from the authorized referral doctors asking that his client’s benefits be reinstated.
“I would hope that my colleague, if he ever encountered that hypothetical, would do the simple thing of sending a questionnaire to the authorized treated physician and asking, ‘Are you aware of the fact that these restrictions are still imposed?’ and give the authorized treating physician an opportunity to say, ‘I’m aware of it and I’m overriding it’ and if they override it, then they would potentially have the right to suspend the benefits,” Johnston said. “To be clear, they can unilaterally stop [claimants], but they have to go through the process.”
Judge Amanda Mercier agreed with the defendant-appellant’s assertion that the articles “an” and “the” do not appear in the statute. Still — plaintiff-appellees argue that while “the” is not there, it’s implied by the singular construction of the language in the statute.
Mercier said that ultimately it isn’t about just the construction of the law, but also the process.
“What’s more important to me is: Do we have a rule that says, ‘This is how you do it. This is the process you follow, and did you do it?’ If those things have been accomplished, if there’s a rule and you followed it, It doesn’t matter if there was a ‘the,’ or there was no ‘the,’ or somebody added a ‘the,’” Mercier said. “If there’s a rule that has been followed customarily, then that’s the rule and that’s all that I’m looking at.”
However, this is another point on which opposing counsels disagree.
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