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Concerns about doctor bias in workers’ compensation evaluations

On Behalf of | Apr 5, 2018 | Georgia Workers' Compensation

Vanessa Sylva is a 54-year-old, former chef in Hawaii. She spent much of her career working for a large-scale catering company–sometimes working as many as 80 hours a week. Her work caused her to suffer tears in each shoulder and numbness down her arms, making it nearly impossible for her to use her hands. After filing a workers’ compensation claim, she was examined by Dr. Leonard Cupo–a doctor selected and paid for by the workers’ comp insurance company. She was denied treatment for nearly a decade, leaving her in chronic pain and restricting her to her home, unable to engage in even simple activities such as playing cards.

The reason–according to a recent lawsuit–is Hawaii’s workers’ compensation law, which allows insurance companies to select the doctors they want to conduct insurance exams. It is the insurance company that pays the doctor–and Hawaii has no limits on how much they can pay. In the case of Cupo, plaintiffs have argued that he received so much from insurance companies, it would have been impossible for him to be objective. Under such circumstances, incentive is high for doctors to deliver findings that enable insurers to veto claims or deny treatments.

How does this compare to Georgia?

In Georgia, an employee who files a workers’ compensation claim may choose an authorized treating physician (ATP) from a panel of approved physicians. There must be at least six physicians on the panel. However, it is the employer who selects which physicians go on the panel, and it is the employer (often by way of the insurance company) who pays for the employee’s medical treatment. This arrangement creates a situation in which there is the potential for doctors to favor the wants of the employer over the needs of the injured employee.

Other options

The system doesn’t function this way across the country. In some states, an impartial doctor is appointed by the state to handle workers’ compensation exams, and the state pays for that doctor. Other states require both the employee and the employer to jointly agree on a doctor.

If you believe you’ve been the victim of unfair physician evaluation in a workers’ compensation claim, it’s worth discussing your case with an experienced attorney to help understand your options.

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