Changing a Doctor for a Work Injury or Illness & Legal Restrictions
Sometimes an employee who is suffering from a job-related injury or illness will decide to change their treating doctor. This is especially true when the employer chose the initial doctor for the employee, who may wonder whether the doctor is serving the employer’s interests instead of theirs. Your treating doctor will have a significant impact on the benefits that you receive, in addition to your medical treatment, so making a change can be critical. You will need to follow the requirements in your state for making the change so that your coverage is not interrupted. Most states allow an injured worker to make at least one change, and some states permit additional changes.
Many employers have set up managed care organizations, which are networks of doctors who provide care to injured employees. If your employer uses this type of network, you may need to select a new doctor who is also within the network.
Restrictions on Changing Your Doctor
A lawyer experienced in workers’ compensation cases may be able to help with the appeals process and evaluate whether an appeal would be worthwhile.
In Florida and certain other states, the insurer will need to choose the new doctor when the employee requests the change. The employee may have a right to appeal the choice of doctor to the workers’ compensation agency in their state. This process tends to be complicated and may not result in the desired outcome.
In other states, such as New York, the employee can choose their new doctor but will need to select a doctor from a list provided by the state. You can find the list online. Otherwise, you may lose benefits for your medical treatment.
In still other states, such as Pennsylvania, an injured worker will need to go through a fixed waiting period before changing a doctor. This may be defined in terms of time or in terms of the number of visits to the initial doctor. If you live in one of these states, you will need to provide notice to the insurer that you are changing doctors, or you may be on the hook for medical bills before you gave notice.
Restrictions on Number of Changes
Many states allow an injured employee to change doctors a certain number of times automatically, without getting the insurer involved. If they run out of automatic changes, they may need to get approval from the insurer to change doctors again. If the insurer does not approve the change, the worker can go to court in pursuit of an order allowing the change.
Getting a Second Opinion
Check state requirements for requesting a second opinion.
Instead of changing their doctor entirely, an injured worker sometimes may simply want a second opinion from a different specialist. This doctor will meet with the employee just once to review their documentation, examine their condition, and offer their opinions. You can submit the opinions of this doctor regarding your disability and treatment needs to the insurer. If your claim is denied, and you pursue an appeal, the doctor’s opinions will be admissible evidence at a hearing.
Second opinions are most commonly sought when a claim has been approved, but the insurer controls the choice of doctor. If your claim has been denied, or if you are not currently receiving benefits, the insurer will request an independent medical examination, which will be performed by a doctor of its choice.