Obtaining Medical Treatment Under the Alabama Workers’ Compensation Act

by HWC Attorney Allwin E. Horn, IV

One of the benefits of the Alabama Workers’ Compensation Act is that as long as an employee is injured during the line, scope and course of their employment, payment for “reasonable” and “necessary” medical treatment for life will remain the responsibility of the employer and/or the employer’s insurance company. This general rule applies even if the accident is the fault of the injured worker. Accidents happen! Employees who have suffered on-the-job injuries can attest to how frustrating the process can be in terms of getting medical treatment approved by the workers’ compensation carrier.

Unfortunately, the Alabama Workers’ Compensation Act, as a general rule, gives the employer/insurance carrier the right to select who the “authorized treating physicians” will be. There are, however, some exceptions to this rule. The primary exception to the rule is that the employee is entitled to a panel of four physicians to select a new doctor if they become dissatisfied with their present authorized treating physician. However, the employer/insurance carrier gets to select the four physicians who are listed on the panel. These rules and regulations can get complex and truly require the help of an attorney who knows the nuances of Alabama Workers’ Compensation Laws, as well as how insurance carriers operate.

If an injured employee suffered multiple injuries, he would be entitled to a panel of four, if desired, in each specialty. For instance, if the employee suffered eye, brain, and spine injuries, he would be entitled to an ophthalmologist for the eye; a neurologist for the brain; and an orthopedist for the spine. Oftentimes, the insurance company will fight the injured worker regarding how many panels are allowed and what specialty is deemed necessary. The insurance carrier is often familiar with the doctors within “its network.” This familiarity can affect the course of allowed treatment, as well as the timing in which it is rendered. The carrier may appoint doctors to the panel who practice in cities far away from the location of the injured worker, which is unreasonable when a similar physician is located in close proximity to the injured worker.

An injured employee deserves all “reasonable and necessary medical treatment” after an injury. Typically any treatment recommended by the authorized treating physician is deemed to be reasonable. However, that does not mean the insurance company will not fight to deny this treatment to avoid paying for it. This treatment can range from physical therapy to complicated surgeries. The insurance company may seek an unauthorized second opinion, or send the case to a doctor for peer review in another state. This tactic is typically designed to slow the process and frustrate the injured worker to the point he gives up on treatment. Reasonable and necessary medical treatment can include many things, not just surgery, physical therapy, and medicine. It can also include apparatuses, including wheelchairs, wheelchair ramps, prosthetics, walk-in showers or tubs, handrails, accessible toilets, and other home modifications.

For all of these reasons, you would be remiss not to ensure you have a qualified Alabama workers’ compensation attorney on your side while determining treatment for your workplace injuries. The insurance company is under no obligation to explain your rights to you. Let our attorneys handle your claim while you focus on healing. You can reach us here for a free and confidential consultation or call us at 844.LAW.TALK or 205.324.3600. You can reach Attorney Allwin E. Horn, IV directly at allwinh@hollis-wright.com.