Choosing a Doctor for a Work Injury or Illness & Legal Requirements
The process of choosing a doctor to treat a job-related injury or illness can have a huge impact on the treatment that you receive and the outcome of your workers’ compensation claim. Their opinion will carry substantial weight in any review of your disability and its effect on your earning capacity. You should be aware that you will need to follow certain requirements under state law to have your medical costs reimbursed by the workers’ compensation insurer. Each state imposes its own set of requirements. However, these requirements do not apply to emergency care. If you need immediate medical attention, you should seek it without worrying about what the workers’ compensation system permits.
Some states allow a worker to choose their own doctor, although they may need to choose a doctor from a list provided by the employer. In other states, a worker must accept the doctor chosen by their employer, although they may have the right to change their doctor later.
Choosing Your Own Doctor
New York, Texas, and certain other states allow a worker to choose their own doctor if the employer has not set up a provider plan or managed care network. The state may provide a list of doctors who are approved to treat job-related injuries and illnesses, but the list should give the worker substantial freedom of choice. California allows a worker to choose their own doctor only if this is their pre-existing primary care doctor, if the employer offers group health coverage, and if they have provided written notice to the employer that they will use their primary care doctor. Critically, the worker must provide this notice before the condition arises. Certain other states provide specific requirements as well.
If you can choose your own doctor, you should look for someone who is experienced in treating your type of condition and who is readily available for appointments. The doctor also should be willing to work with the workers’ compensation payment system. They should be familiar with the issues that can arise in the workers’ compensation claim process so that they can help you deal with any opposition from the insurer. This will involve documenting your condition in detail and being prepared to testify in support of their opinions and recommendations.
Choosing a Doctor Within a Designated Network
Many employers and insurers arrange for treatment through a provider network or managed care organization when an employee suffers a work-related injury or illness. The employee still has some control over their doctor, but they will need to select a doctor within that network. Similarly, employers in some states give employees a panel of providers from whom they can choose. State laws provide minimum requirements for the number of doctors and specialists who must be included in the panel. An employer may not be allowed to include more than a certain number of clinics.
When the Employer Chooses the Doctor
Florida and certain other states require an injured employee to seek treatment from a doctor chosen by their employer. This may involve just one initial consultation with the employer-chosen doctor, or you may need to see that doctor for a certain period of time. Getting treatment from an employer-chosen doctor is not ideal because they may have an incentive to advance the employer’s interests instead of yours. You may want to change doctors if you are concerned about this conflict of interest.
