Getting Medical Treatment for a Work Injury or Illness & Legal Considerations for Workers
If you suffer a workplace accident or develop an occupational disease, you should seek treatment promptly. Regardless of whether you believe that the injury is serious, you will want a doctor to review your symptoms and start developing a record that can support a claim for workers’ compensation benefits. Taking prompt action also will give an insurer less reason to suspect that your injury is not job-related or that it is less severe than you are alleging.
A worker who has an urgent need for medical attention should get treatment in an emergency room. There are no specific rules that govern emergency room care. However, the workers’ compensation system provides certain rules for seeking non-emergency medical treatment. You will want to follow these rules to preserve and maximize your benefits. Some states require the employer or insurer to choose a worker’s doctor, for example, while other states allow the worker to choose their own doctor only under certain circumstances. Additional rules may apply to changing a doctor.
Why the Doctor Matters
Whether the employer (or insurer) or the employee chooses the doctor can have a huge impact on the employee’s treatment and benefits. This is because doctors chosen by employers and insurers have a financial incentive to act in the interests of those entities, since they want to receive more patients from them. If you can choose your own doctor, you can have greater confidence that they will bear only your interests in mind.
At a minimum, you should choose a doctor who is licensed and qualified to treat your condition. Ideally, you will want to select a doctor who has handled many cases similar to yours and who communicates well with you. They will diagnose your condition, oversee any treatment that you need, and provide documentation of your condition as it progresses. This may involve submitting written reports to the insurer or a court, and it may even involve testifying on your behalf. The doctor will need to be able to show why a certain course of treatment is necessary and reasonable if the insurer challenges it.
Meeting With the Doctor
A Doctor’s Role
A doctor’s role is very important, since their records and testimony will directly influence the extent of workers’ compensation benefits granted.
You should be candid in any conversation with your doctor. They will conduct objective tests to analyze the extent of your condition, but each person’s experience of their symptoms is unique. While you do not need to exaggerate your discomfort or limitations, you should not minimize the effect of your condition in an effort to be optimistic. You should try to be as thorough as possible in describing your symptoms, rather than discussing only the symptoms that seem important to you. Something that seems minor or unrelated may actually play a key role in a doctor’s diagnosis. They will have the knowledge and experience to sift through all of the information that you provide.
If you are not sure about the answer to a question that a doctor asks, you can feel free to say that you do not know. Making a guess can undermine your claim down the road by harming your credibility or waiving your right to certain benefits. Most importantly, you should be absolutely sure that you have recovered completely from a condition before saying this to a doctor. It is wise to err on the side of caution, especially if the condition arose recently. You may not know whether symptoms will recur or change in the future.
Coverage for Medical Bills
Until the insurer makes a decision on your claim, it usually must cover your medical bills. If the insurer approves your claim, it will cover the bills for any approved medical treatment. If the insurer denies your claim, and you pursue an appeal, you will need to pay for your own medical expenses during the course of the appeal. If the appeal succeeds, you can get reimbursed for those costs. You may want to find out if your state has a temporary disability insurance program. This can cover some of your medical costs during the course of the appeal if you meet its eligibility requirements.
If your claim has not yet been approved, a doctor might agree to set up a lien for your treatment costs. This means that they would seek payment from any benefits that you eventually receive through workers’ compensation.