Can an employer legally terminate an employee’s workers’ compensation benefits based solely on a referred specialist’s clearance to return to work?
The answer is no, according to the Georgia Court of Appeals. The court found that an employer improperly terminated an employee’s benefits by failing to include the treating physician’s opinion.
Treating doctor refers injured worker to specialist
Justin Sebastian was a police officer for the city of Atlanta. He was injured in a work-related crash in December 2017 and was able to collect workers’ compensation benefits.
Sebastian’s treating physician released him to light duty, which involved performing only office tasks, on April 25, 2019. The doctor continued to treat Sebastian for issues relating to his cervical spine, shoulder, arms and wrist.
On September 16, 2020, the treating doctor referred Sebastian to a cervical spine specialist for additional evaluation. The specialist found that Sebastian was capable of unrestricted employment as far as his spine issues were concerned.
A few months later, Sebastian’s spine problems flared up and his treating doctor once again restricted him to light duty.
Specialist’s release to work results in termination of benefits
In February 2021, Sebastian returned to the specialist, who released him to full duty work. This resulted in the city unilaterally suspending Sebastian’s workers’ compensation benefits.
Sebastian filed to reinstate his benefits, arguing that since the specialist wasn’t his treating physician, the benefits couldn’t be suspended.
An administrative law judge agreed and reinstated the benefits. On review with the state’s Workers’ Compensation Board, the judge’s decision was affirmed and the superior court upheld that finding.
‘Clear distinction between treating physician, referred specialist’
The Georgia Court of Appeals found that while the state Workers’ Compensation Act didn’t have a definition for “authorized treating physician” it did provide for the appointment of a doctor to oversee an injured worker’s medical care. That doctor is authorized to refer the worker to a specialist or another doctor for treatment.
There is a clear distinction in the law between the authorized treating physician and a referred specialist, the court said. That distinction is that “any medical practitioner providing services as arranged by a primary authorized treating physician under this subsection shall not be permitted to arrange for any additional referrals.”
According to the court, there was sufficient medical evidence revealing that the spine specialist was not the authorized treating physician. That meant that Sebastian’s benefits were improperly suspended since the employer based the termination without input from the authorized doctor.
