When you're recovering from a work injury, it is important to have a good relationship with your treating doctor. Your doctor will not only provide important medical treatment but will also refer you to specialists, set your work restrictions, and decide whether you have a permanent disability. If your treating doctor does not support your workers' comp claim, the insurance company will typically deny benefits.
If you are unhappy with your treating doctor, you may be able to change physicians. However, workers' compensation laws vary from state to state. Make sure you understand the rules and procedures in your state before changing workers' comp doctors. If you fail to follow the correct process, the insurance company may refuse to pay your medical bills.
In an emergency, you have the right to seek treatment from any doctor or hospital. However, for non-emergency treatment, you will need to follow your state's workers' compensation rules. In many states, your employer or its insurance company has the right to select the treating doctor who will provide your ongoing medical care. In other states, you can pick your own doctor from the very beginning. And, in still other states, the rules are more complicated—for example, you might need to select a doctor from an approved panel or network from your employer. (To learn more, see our article on who selects your initial treating physician.)
Sometimes, you may feel that your occupational doctor is more concerned about your employer's financial well-being than your full recovery. If your condition is not improving or you are dissatisfied with the doctor's medical care, you may be able to change doctors. Every state's workers' comp system is different. In most states, you can change doctors at least once. However, depending on where you live, there may be other limitations on your ability to change medical providers.
Some states allow the insurance company to control all medical treatment in a workers' comp case. In these states—such as Florida, New Jersey, North Carolina, and Virginia—you may ask for a new doctor, but the insurance company will typically select the new doctor for you. If the insurance company denies your request, you can usually appeal the decision to your state's workers' compensation agency. However, appeals regarding medical treatment can be tricky, so you may want to consider hiring an experienced workers' comp lawyer for help.
Other states, including Pennsylvania and Michigan, allow workers to switch physicians after a waiting period. The length of the waiting period varies from state to state (ranging from one appointment to 90 days). However, after that time period, you may treat with a doctor of your own choosing . You should not start treating with a new doctor until you give the insurance company adequate notice. Otherwise, you may be billed for treatment received before you gave notice.
Another group of states allows you to change physicians but limits the number of times you can do so. For example, in Illinois, you can change doctors twice without the insurance company's permission. (After your second change, you must get either the insurance company's approval or a court order before switching doctors.) Georgia allows a one-time change of physician. If you've used up your automatic changes and are still unhappy with your treatment, a workers' compensation lawyer can help you request approval for an additional change.
Some states, including New York and Washington, allow workers to choose their treating doctors. However, they have a directory of medical providers who are authorized by the state to treat injured workers. If you treat with an unauthorized doctor, the insurance company may not pay the doctor's bills. These states typically have an online directory of authorized doctors. While you may be able to change physicians, you must treat with an authorized provider.
A managed care organization (MCO) is a network of physicians that treat injured workers. MCO's are an increasingly popular way to reduce workers' comp expenses for employers. If your employer provides treatment through an MCO or provider network, you typically may change physicians, but your new doctor must also be within the network.
If you're not able to change doctors, you may still be able to get a second opinion in some states. In general, a second opinion doctor does not provide ongoing treatment. Instead, the doctor will perform a one-time examination, review your medical records, and give recommendations on your treatment, work restrictions, and limitations. The insurance company will consider the second opinion report and findings when assessing your workers' comp claim. A second opinion can also be used as evidence at a workers' compensation hearing if your benefits are denied.
Second opinions are usually available when the insurance company has control over your medical care and selects your treating doctor. The process for requesting a second opinion varies from state to state. Typically, if your claim has been denied, the insurance company will not pay for a second opinion. Instead, your workers' compensation lawyer may send you to an independent medical examination with a doctor of his or her choosing. Contact a workers' comp lawyer or your state's workers' compensation agency for more information and assistance.
When you choose a new doctor, you should consider a series of factors, including:
It is important that you trust the provider and feel comfortable with his or her treatment recommendations. If you need help finding a doctor, a workers' compensation lawyer may be able to recommend a physician, especially if you need to select one from your employer's network. Workers' comp lawyers are often familiar with occupational doctors and can tell you which ones are likely to be open-minded and fair.