If you have an injury or illness that might be covered by workers’ compensation, it’s important to take the right steps when seeking medical treatment. Getting appropriate medical care is important, not only for your health and recovery, but also for maximizing your workers’ comp benefits and making sure that you’re properly compensated for your injuries. (See our article on filing a workers’ compensation claim to learn how to start the process for getting benefits, including payment for your medical care.)
You should seek treatment right away for any injury, even if it seems minor. This means seeing a doctor immediately after a work-related accident or at the first sign of any symptoms that might be due to your work duties or to toxic exposure on the job. Getting prompt treatment serves two important purposes: First, early treatment makes it more likely that you’ll recover from your injuries faster. Second, the closer in time to your accident that you receive treatment, the less room it gives your employer (or its insurance company) to argue that your medical condition isn’t related to your work.
No matter what, you should resist the urge to “tough it out” or downplay the seriousness of your injuries. This can delay or impede your recovery, and it can affect the scope of treatment authorized by workers’ comp or the amount of benefits you ultimately receive.
If you need immediate medical attention, you should go to the nearest emergency room. If it’s not an emergency, however, you’ll need to follow your state’s rules for getting medical care. Some states give you the right to choose the doctor who will treat you for your injuries (called your "treating doctor" in workers' comp lingo), while others give that right to your employer or its insurer. Still other states have more complicated rules for selecting a treating doctor. For example, in California, you can choose your treating doctor only if you officially designated your personal primary physician for that purpose before the accident, and you have health care coverage (see details on selecting treating doctors in California workers’ comp cases). And in Massachusetts, your employer can require you to see a health care provider within its preferred provider arrangement (if it has one), but only for the first visit; after that, you can switch to your choice of treating doctor (Mass. Gen. Laws ch. 152, § 30 (2018)).
Although doctors hired by employers or insurance companies are supposed to be objective, they often have close and financially rewarding relationships with the employers and insurers that refer cases to them. Because of this, it’s in your best interest—whenever possible—to receive treatment from a doctor you know and trust.
When you have a choice, make sure you select a doctor who’s both experienced and articulate. Your treating physician will play an essential role in your workers’ compensation case. In addition to making decisions about your diagnosis and the treatment you should receive, the doctor will often have to write reports (and sometimes give testimony) that will affect when you can return to work and the benefits you’ll receive, including payments for temporary disability and permanent disability. So it’s important that the treating physician can clearly and convincingly explain the reasons behind his or her decisions. (Learn more about the role of the treating doctor in your workers’ comp case.)
In any case, make sure that you obtain treatment through the correct avenues and from a properly licensed or credentialed doctor. Otherwise, you run the risk that your medical bills will not be covered.
Even with the advancement of medical technology, doctors still rely on patients to report symptoms, severity of pain, and activities that are difficult or impossible to perform. This is especially true for soft tissue injuries; these injuries don’t involve bones and often cannot be verified through medical imaging like x-rays. Because some injuries can be more subjective in nature, it’s especially important for you to communicate with your doctor about what you’re feeling. In doing so, you should follow these guidelines:
In most states, your employer is required to pay for your medical bills until a decision has been made to accept or deny your claim, at least up to a certain amount. If your claim is approved, your employer will continue to pay for your medical bills for approved treatment.
If your workers’ comp claim is denied, you can pay for your own bills and seek reimbursement from the insurance company if and when the denial is overturned on appeal. Some doctors might agree to treat you on what’s called a “lien basis,” meaning that payment for your bills will come out of any recovery you get through workers’ comp. In the meantime, if your state has a temporary disability insurance program, you may be eligible to apply for these short-term benefits to make up for some of your out-of-pocket costs.
Workers’ comp cases can be difficult to navigate, especially if your employer’s insurance company is fighting your claim or refusing to authorize medical treatment (like surgery or other expensive procedures) that your treating doctor has recommended. Getting the help of an experienced workers’ compensation attorney can be invaluable in making sure you’re fully compensated for your loss and able to get all the medical treatment that you need. A local lawyer with workers’ comp expertise may also be able to refer you to doctors who can provide proper care as well as strong medical evidence to support your case. (Learn more about what a good workers’ comp lawyer should do for you.)