Can I choose my own doctor for a Work Comp injury?

by Steve Fields | November 25th, 2016

As a general rule, you always have the option to choose your own doctor. We typically recommend you see your primary care doctor, not a Work Comp doctor. If you don’t have one, you should see a family physician who can give you a referral.

If you want a second opinion, our workers compensation attorneys may be able to help find a doctor who specializes in the treatment of your type of work injury. We can also refer you to a qualified rehabilitation consultant (QRC) who may also be able to offer suggestions on where to treat.

Once you have treated twice with that health care provider, it is considered your primary care provider. You can change primary care providers without authorization once within the first sixty days after you begin treatment for your injury. But once a primary care provider is designated and sixty days have passed since your first treatment, any change of primary provider must be approved by the insurance carrier, the Department of Labor and Industry, or a Workers’ Compensation judge.

Can my employer require that I see a Work Comp doctor?

If your employer or the workers’ compensation insurer tells you that you have to treat with a specific doctor for a workers’ compensation injury, you can respond with confidence that, no, you do not.

Unless there is a contractual arrangement where both parties agree on employer-directed medical treatment – say, a professional athlete, the military, or some other such special circumstance where optimal physical and mental health are essential terms of employment – the employer simply cannot dictate the course of your medical treatment, work injury or otherwise.

Of course, when it comes to workers’ compensation, things are a little more complicated than that. While they cannot dictate your treatment, employers and insurers certainly can and very often will attempt to influence your medical treatment for a work-related injury.

The problem lies in the idea that since the employer / insurer pays for the medical treatment, it should be able to exercise some control over its purchase and costs. Thus, medical treatment and provider choice under a workers’ compensation claim is limited somewhat by the law, but never to the extent of absolute employer-directed care.

The first and biggest limiting factor on choice of medical treatment for a workers’ compensation injury is the notion of the “primary care provider”. When you get hurt at work, you can initially choose to treat wherever you want.

The second limiting factor occurs under the special circumstance where the employer / insurer administers its workers’ compensation claims under what is known as a “certified managed care plan”. Basically, this means the employer / insurer chooses a preset network of health-care providers to administer its workers’ compensation claims.

It is similar to the “in-network / out-of-network” setup in private health care coverage. In other words, you are free to choose whatever provider you want as long as it is within the managed care plan network. Treatment with providers outside of the managed care plan, however, will not be covered by the workers’ compensation insurer.

What if they want me to attend an Independent Medical Exam?

An Independent Medical Exam (IME) is often scheduled for work-related injuries. The doctor is chosen by the insurer or employer and an appointment is scheduled within 120 days following your workers compensation claim. You are required by law to attend an IME, as part of the workers comp claim process.

While the IME doctor may agree with your primary care doctor regarding your work injury and work restrictions, it is far more common that they will render an opinion that is favorable to the work comp insurer and your employer. They may find that your work injury was temporary, or that your injury was not as limiting as your restrictions claim. They may even find that your injury was not caused by your work-related duties, despite the medical records which show the injury was work-related.

If the workers compensation insurer is sending you to an IME, it is very likely that they are preparing to discontinue paying your work comp benefits. It is important to have an attorney on your side before this happens. That’s where we can help.

At Fields Law Firm, our Workers Compensation attorneys are here to help protect your rights and ensure you receive the benefits you deserve. We will help you understand your legal options and make sure you’re taken care of, both now and in the future. Call us today at 1-888-343-5375 for free, no-obligation advice.