If You Have a Workers' Comp Injury, Can You Choose Your Own Doctor?
NOTE: INJURED WORKERS' ALLIANCE STRONGLY ADVISES THAT YOU AVOID EMPLOYER OR INSURER RECOMMENDED DOCTORS.
In Oregon Workers' Compensation, unless your insurer has enrolled you in a managed care organization (MCO), you can treat with any health care provider who qualifies as an attending physician under Oregon law. Your employer cannot choose your health care provider for you.
Written by: Attorney Lindsey Shafar
Your ability to choose your own doctor for treatment related to a work-related injury covered by workers’ compensation depends on the state where your claim is filed. Some states require that an injured worker be seen by a doctor chosen by the employer or the employer’s workers’ compensation insurance carrier. Other states allow injured workers to choose any doctor within a network, and admission to the network is determined by the state, the employer, or the employer’s insurance company. Rules also vary for whether you can choose a doctor for the initial treatment visit as compared to continuing treatment for your industrially related condition.
Keep in mind that your regular physician may or may not treat injured workers. Rules for treating injured workers -- and receiving payment for the treatment -- are complicated and different from most regular health insurance billing systems. For that reason, your doctor may choose not to treat work-related injuries. Your doctor can probably direct you to another physician specializing in treatment of injured workers. If this occurs, you can still seek treatment for any conditions not related to your workers’ compensation claim from your regular physician.
Initial Doctor's Visit
In most states, you are permitted to receive treatment from any physician you choose for the initial visit. Emergency room visits will be covered if your injury requires emergency care.
Tell your health care provider at the initial visit that you were injured at work. This will ensure that the doctor is aware that you may have a workers’ compensation claim and can act accordingly. Your doctor will likely be required to fill out certain forms regarding your industrial injury, so it is important that you tell your health care providers that your injury occurred at work.
In other states, such as California, you must initially see a doctor chosen by your employer, if your employer has established a medical provider network for workers' comp claims (except in the case of emergency). If you are unhappy with the doctor, you can request to see another doctor (that is, you may get a second opinion).
Ongoing Medical Treatment
Your state will likely have regulations regarding which health care providers can treat injured workers.
First, most states have rules regarding the types of providers that can be your "attending," or "treating" physician for workers' comp purposes. For example, in Oregon, your attending physician may be an M.D., a D.O., or an oral surgeon. In contrast, in Washington, your attending physician may be an M.D., a D.O., a registered nurse practitioner, or a physician’s assistant.
States may allow you to seek treatment from other providers, such as chiropractors, naturopaths, or other specialists, but may limit the number of visits your workers’ compensation claim will cover. (Massage therapy, physical therapy, and chiropractic treatment are often limited in the number of sessions you may receive.) If your injury requires specialized care, such as dental treatment, orthopedic surgery, or the like, your attending physician will be able to recommend a specialist authorized to treat injured workers.
Second, most states utilize some form of network system in which health care providers must show certain competencies regarding workers’ compensation claims to be admitted to the network. In many states, admission to the network is governed by criteria established by the state. In other states, such as California, employers can create their own network of doctors and require their injured workers to treat within that network.
To find an appropriate treating physician, consider first talking to your current primary care physician. Your current physician will be able to determine if he or she can treat you for your work-related injury. If your current physician cannot treat you, or you do not have an established relationship with a physician, consider talking to a worker's comp lawyer in your area. The attorney will be familiar with local health care providers who treat injured workers and can suggest a medical provider for your specific needs.
The most important thing to remember is that you need an treating physician able, by law, to treat you for your industrial conditions. If your physician is not authorized to treat you, there is a strong possibility your employer, the state, or the employer’s insurance company will not pay for your medical bills, and your medical records may not be acceptable as evidence.
Your Treating Physician’s Role
In choosing a treating physician, consider the important role your physician will play in your workers’ compensation claim. Your attending physician is not only responsible for treatment of your work-related injury, but may also be able to authorize time off work and dictate any physical work restrictions you should have in the future.
You Can Change Treating Physicians
In most states, you are permitted to change your attending physician if you are not satisfied with the care you are receiving. Some states limit the number of times you can change physicians, or may require approval from your employer if you exceed the number of changes permitted without approval. Always consult with your employer or its worker's comp insurance carrier before changing physicians.
In other states, such as California, if your employer has established a medical provider network, you can change doctors only within the network. If you are not happy with the new doctor, you may request another change. If you still aren't happy with the doctor, you can request a doctor out of the network.
If you do choose a new physician, make sure that your new treating physician completes any necessary forms documenting the change in treating physicians. This will ensure that your workers’ compensation claim continues to be administered properly.
Payment of Your Medical Bills
Your medical bills will not be paid until you have filed a workers’ compensation claim. To ensure that your bills are paid timely, tell your employer as soon as possible that you were injured at work. Your employer will then provide you with the forms necessary to file your workers’ compensation claim.