In most Alabama workers’ compensation claims, there are many different individuals and parties who have important roles during the life of the claim. Some have more important roles than others.
To get a better understanding of who these people are, we are outlining the basic roles of each character in the claim.
Who are the parties?
What are their roles and interests?
There may be a few others involved, but this should be a fairly comprehensive list.
The employee is the person who is injured on the job and making a claim for workers’ compensation benefits.
The employer is the business entity that hired the employee who was injured on the job.
Administrator or carrier
Third-party administrator/workers’ compensation carrier is the organization that carries the insurance coverage on behalf of the employer. They have the responsibility of investigating the claim to determine whether benefits will be paid.
Case nurse/case manager
The case nurse is hired by the insurance carrier to facilitate the medical care appointments of the injured employee.
Initial treating physician
Initial treating physician (or sometimes called “Gatekeeper”) is typically paid by the insurance carrier to examine and diagnose what injuries were sustained by the injured employee in the workplace accident or exposure.
The specialist is sometimes utilized in work comp cases when a particular body part is injured and requires specialized medical care.
Authorized treating physician (ATP)
The ATP is the approved medical provider for the injured employee.
Primary care physician (PCP)
The PCP is the injured employee’s personal doctor who usually is not approved by the insurance carrier to provide medical care relating to the work comp claim.
A radiologist is sometimes called upon to take diagnostic films such as X-rays, MRI’s or CT scans to help diagnose particular injuries.
The Panel of Four choice is a list of potential new authorized treating physicians that the injured employee can choose from that is authorized to provide medical care by the workers’ comp insurer.
Utilization review doctor
Utilization review doctor is asked by the insurance carrier to review the proposed medical care being offered to the injured employee. Their decision whether to agree or disagree on medical care impacts the employees’ rights.
A physical therapist is brought into the workers’ comp process when the authorized treating physician believes that conservative care pre or post-surgery is the best medical option for the injured employee.
Pain management doctor
The pain management doctor treats the injured employee when the current authorized treating physician believes that pain management is the best medical care for the injured worker.
Transportation services are utilized when the injured worker does not have their own method of transportation. The use of transportation services must be approved beforehand by the insurance carrier before it may be utilized by the injured worker.
A private investigator is usually hired by the insurance carrier or the employer to do surveillance on the injured worker during the time the injured worker is away from work due to injury.
A vocational expert can be hired by either the employer/insurance carrier or the lawyer for the injured worker to determine whether a vocational loss is part of the damages for the injured worker in their workers’ comp claim.
Functional capacity evaluation therapist
A functional capacity evaluation therapist is typically hired by the authorized treating physician at the end of the healing phase to determine the functional ability and limitations of the injured worker before they return to the workplace.
Third-party pharmacy suppliers mail medicine to the injured worker usually when the injured worker cannot physically pick up their medicine at a brick-and-mortar pharmacy.
The plaintiff’s attorney is the lawyer who represents the injured employee in the workers’ compensation matter.
The defense attorney is the lawyer who represents the employer and/or the insurance company that is providing the workers‘ compensation insurance coverage for the employer in the workers’ compensation matter.
Alabama’s State Ombudsman is often utilized to mediate disputed work comp claims between the parties. They have similar but limited authority to a Circuit Judge in handling these matters.
Circuit Court Judge
Circuit Court Judge will try disputed workers’ compensation claims as well as have best interest hearings to finalize settlements.
When to hire an Alabama work injury attorney
If you or a loved one were hurt on the job due to unsafe working conditions, it’s important to seek legal counsel as you may be entitled to workers’ compensation or other benefits. Since 1967, Nomberg Law has protected the legal rights of our clients—those who are hurt on the job while working for Alabama employers.
Bernard D. Nomberg has been a lawyer for more than 25 years. Bernard has earned an AV rating from Martindale-Hubbell’s peer-review rating. In 2021, Bernard was named a Super Lawyer for the 9th year in a row.
When you are ready to learn your rights, contact the Nomberg Law Firm to schedule your free consultation.
*Thanks to our friend and colleague Annemarie Pantazis from North Carolina for coining the phrase “Workers’ Compensation Industrial Complex.” We think it fits!