Role of the Treating Doctor in Your Workers' Compensation Case

Your doctor makes important decisions, including when you return to work and whether you're permanently disabled.

Reasonable and necessary medical care is one of your most valuable workers’ comp benefits. It’s important to choose a doctor who will not only treat your injuries, but also advocate on your behalf in your workers’ comp case. Below, we discuss the importance of your treating physician—and how to change doctors if necessary.

Why Is My Treating Doctor Important?

Your treating doctor’s opinion will carry significant weight in your workers’ compensation case. Unlike a doctor who examines you once, your treating doctor monitors your recovery over time. This gives your treating doctor a better understanding of your injuries, your need for medical treatment, your ongoing physical limitations, and the likelihood of a full recovery.

Your doctor will make important decisions in your case that will directly affect your recovery and benefits, including:

  • Diagnosing and treating your condition. In order to receive workers’ comp benefits, you’ll need a medical diagnosis from a doctor. Your doctor will also direct all of your medical care, deciding whether you need physical therapy or medications, for example.
  • Referring you to specialists. In most cases, your doctor will need to sign off on any referrals to a specialist, such as a surgeon or orthopedist. Your doctor’s willingness to listen to you and get you the treatment you need is essential.
  • Deciding your work restrictions. Your treating doctor will decide if you need time off work, giving you a chance to recover and receive partial wage benefits (called temporary disability benefits). Your doctor will also decide when you’re able to return to work. If you’re sent back to work too early, or without any work restrictions, you might injure yourself further.
  • Determining your level of permanently disability. Once you reach maximum medical improvement—when your condition is stable and will no longer improve—your doctor will evaluate whether you have a permanent disability and assign you an impairment rating. This rating will be used to calculate how much you’ll receive in permanent disability benefits. (For more information, read our article on permanent disability benefits.)
  • Providing evidence in your case. At every appointment, your physician will create medical records that will serve as valuable evidence in your workers’ comp case. Careful and consistent documentation of your injury, treatment, and recovery can lead to fewer disputes with the insurance company. Your doctor will probably also need to testify on your behalf, either in a deposition or at a workers’ comp hearing.

Who Chooses My Treating Doctor?

The rules about who selects the treating doctor vary from state to state. In some states, you can choose your own doctor from the very beginning. For example, in California, you may “predesignate” your primary care doctor to treat your work injuries at the time of hire. In other states, you might be limited to choosing a doctor from your employer’s established health care network or from a list of approved physicians. Finally, some states let your employer choose your initial treating doctor.

Treating With a Company Doctor

If you live in a state that allows your employer or its insurance company to choose your doctor (sometimes called a “company doctor”), you might find yourself receiving substandard care. While some company doctors are unbiased and provide high-quality treatment, others tailor their treatment to minimize the insurance company’s expenses. For example, it’s not uncommon for a company doctor to send an employee back to work too quickly or deny a necessary surgery because of the expense.

Because your treating doctor’s opinions will have serious impacts on your health and your workers’ comp benefits, you need a doctor that focuses on your recovery—not on the insurance company’s financial interests. If you’re worried about the company doctor’s potential conflict of interest—or you’re unhappy with your medical care and lack of improvement—consider changing doctors. In nearly all states, you can change doctors at least once in your workers’ comp case. However, you need to follow the proper procedures in your state. (To learn more see our article on how to switch workers’ comp doctors.)

Factors to Consider When Choosing a Treating Doctor

If your state lets you choose your treating doctor, you should take advantage of this opportunity and carefully weigh your options. You should research doctors in your community and consider their:

  • level of experience and skill
  • area of specialization (such as orthopedics or neurology)
  • familiarity with your type of injury
  • understanding of workers’ comp claims and willingness to advocate on your behalf
  • willingness to accept your state’s workers’ comp medical fee schedule
  • availability for appointments, and
  • proximity to your home.

The doctor’s personality is also important. You should trust your doctor and feel comfortable discussing your conditions and concerns with him or her. To learn more, see our article on finding a treating doctor in your workers’ comp case.

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