Workers’ compensation pain treatment in Georgia and Tennessee

Medically reviewed by Joshua L. Hare, DO (Doctor of Osteopathic Medicine), Founder & Medical Director

What we treat after a work injury

Work injuries come in two patterns, and we see both: a single event such as a lift or a fall, and strain that builds over months of repeated motion or overhead work. We treat the pain the way we treat any other patient’s pain: find the structure that is generating it, then target it directly.

• Back pain and neck pain, including disc and facet-joint injuries
• Radiating arm or leg pain where a nerve root is involved
• Shoulder, knee and other joint pain
• Repetitive-strain and overuse injuries

The clinical detail — symptoms, when to see a specialist, and the treatment options — is on the work injury pain page.

How the injury is diagnosed

Imaging alone often cannot say which structure is causing the pain. Degenerative changes show up on many adults’ scans and are frequently painless. Diagnostic injections under live X-ray guidance can help identify the source, and the same route is used to treat it.

In a work-injury case that matters beyond the treatment itself. Work restrictions, duties and the recovery plan all rest on knowing what is actually injured.

Common starting points: lumbar epidural steroid injection, lumbar facet joint injection and radiofrequency ablation. None of these is scheduled until the physician has gone over its risks, the alternatives, and what each is likely to achieve.

Which state’s rules apply to your claim

Georgia and Tennessee run different workers compensation systems, and which one applies depends on your claim, not on which of our clinics you visit. Two of our clinics are in Georgia and three are in Tennessee, and many people here live in one state and work in the other. If you are not sure which state your claim is filed in, your employer or the claim’s adjuster can tell you. Then use the section for that state.

On a Georgia claim: choosing your doctor

In Georgia your employer decides how medical care is routed. Under State Board of Workers’ Compensation Rule 201, the employer either posts a panel of at least six physicians,[1] or contracts with a workers compensation managed care organization certified by the Board. A traditional posted panel must include an orthopedic physician, and no more than two of its physicians may be from industrial clinics.

You choose a doctor from the list, and you may make one change to another doctor on the list[2] without your employer’s permission. Any further change goes through the Board’s change-of-physician process.

The doctor you choose becomes your authorized treating physician. That physician may arrange a referral to a specialist, including a pain specialist, without prior authorization from the Board. A specialist who treats you on that referral is not permitted to arrange further referrals, so recommendations go back to your treating physician.

If your employer never posted a panel or offered any of these choices, and the claim is not in dispute, you may select a physician who is not on a panel. Once your employer has been notified, that physician becomes your authorized treating physician, and you keep the right to one further change.

Report a work injury to your employer immediately, and no later than 30 days after the accident. For accidents on or after July 1, 2013, medical treatment is limited to a maximum of 400 weeks from the accident date unless the injury is catastrophic. Mileage and other expenses for medical care are reimbursable when the request reaches the insurer within a year of the expense, and mileage is paid within 15 days of an itemized written request.

On a Tennessee claim: the panel and specialist referrals

In Tennessee most employers must give you a panel of physicians on the state’s Employee’s Choice of Physician form, the C-42, within three business days of receiving notice[3] of the injury. The panel lists at least three independent physicians in your community, no more than two of them in the same practice or at the same location. If three cannot be found locally, the search extends to a 125-mile radius. Employers must use the official form.

You choose from that list. The physician you choose becomes your authorized treating physician and is in charge of your care for as long as it is necessary.

If your treating physician refers you to a specialist, your employer can either provide a panel of specialty physicians or allow the referral to stand. Under Bureau rule 0800-02-01-.06,[4] the employer is deemed to have accepted the referral unless, within three business days, it provides a panel of three or more specialists. Even then, the choice among those names is yours.

Tennessee has adopted the ODG treatment guidelines together with the Tennessee Department of Health chronic pain guidelines. Treatment provided by or at the direction of the authorized treating physician in accordance with those guidelines is presumed to be reasonable and necessary,[5] and that presumption can be rebutted only by clear and convincing evidence.

On a compensable claim, treatment is at no cost to you[6] for as long as the authorized treating physician relates it to the work injury, and travel of more than 15 miles one way for treatment with an authorized provider is reimbursable.

How treatment gets authorized

On a Georgia claim. Under the Board’s rules, advance authorization is not required as a condition of payment for treatment ordered by an authorized treating physician, although a certified managed care organization may provide for precertification by contract. A provider may still ask the insurer to pre-approve a treatment on Board Form WC-205. The insurer has five business days to respond, and if it does not, the treatment stands pre-approved. An insurer that refuses must, within 21 days, either authorize the treatment in writing or file a Form WC-3 with the Board stating its grounds.

On a Tennessee claim. Acceptance of a specialist referral is not authorization of a specific procedure; treatment requests are reviewed against the adopted guidelines above.

For referring offices. In Georgia an authorized treating physician may refer to a specialist without prior authorization from the Board, and the referred specialist cannot refer onward, so our recommendations return to you. In Tennessee your referral is treated as accepted unless the employer provides a specialty panel within three business days. Adjusters and nurse case managers may fax referrals to (866) 568-6713.

Impairment ratings and return-to-work documentation

Two documents come up as a work-injury claim moves along: the impairment rating, and the note that says what work you can do.

On a Georgia claim. Georgia routes this through the authorized treating physician, who determines the rating.[7] The standard is fixed by statute, O.C.G.A. § 34-9-263(d), and by Board Rule 263:[1] the rating is based on the AMA Guides to the Evaluation of Permanent Impairment, fifth edition. Under Board Rule 263[1] the employer or insurer requests the rating in writing from an authorized physician once your weekly income benefits end and no rating has yet been requested or issued. Not every injury results in a rating.[8]

Form WC-104 is the notice your employer or its insurer sends you saying a physician has released you to work with restrictions or limitations,[1] and the date of that release is what sets when your benefits may change from temporary total disability to temporary partial disability.[1] A job offer comes on Form WC-240, the notice of an offer of suitable employment, and it needs your authorized treating physician’s approval after an examination within the previous 60 days.[1]

On a Tennessee claim. Your authorized treating physician assigns the permanent impairment rating and sets the maximum medical improvement date[9] for the injury they are treating. Where different physicians are treating separate injuries, each one rates only the injury in their care.[9] The AMA Guides sixth edition applies to injuries on or after January 1, 2008, and the edition in effect on the date of injury is the one that governs the claim.[10] For injuries on or after July 1, 2014, Tennessee law does not let the rating physician count complaints of pain in the impairment percentage.[10]

Your physician’s restrictions may limit your hours or the type of work you do, and the Bureau tells injured workers it is very important to follow them at all times.[11] If your employer cannot meet them, you stay off work and your disability benefits continue.[12]

Insurance and coverage

We accept most workers compensation plans. The insurance page lists the carriers we accept, and our team verifies coverage before the first visit.

Getting started

Call the clinic nearest you — the direct lines are in the clinic list below. Tell the team it is a work injury and which state the claim is in. Bring any imaging discs or reports you already have, the paperwork your employer gave you, and the claim number if you have one. What to expect at a first visit is on the new patient page.