If you suffered an injury at work or while performing your work duties, it’s important to take the right steps when seeking medical treatment. Getting appropriate medical care is not only important for your health and recovery, but also for maximizing your workers’ compensation benefits and making sure that you’re properly compensated for your injuries. (For more information about how to initiate a workers’ compensation claim, see Nolo’s article Filing a Workers Compensation Claim).
With any injury, even injuries that seem minor, you should seek treatment right away. 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. Being treated soon after you’ve been injured 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 injuries are not work-related.
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 for treatment. For non-emergency situations, you’ll need to follow your state’s rules on the proper channels for obtaining medical care. Some states give the employee the right to choose the doctor who will treat you for your injuries (called your "treating doctor" in workers' comp lingo), while others give the employer that right. Still other states have more complicated rules for selecting a treating doctor. For example, in California, the employee must see a doctor within the employer's medical provider network, unless the employee took steps to officially designate a treating physician prior to the accident. Or, in Massachusetts, the employer can choose the doctor for the initial visit, but the employee can select the doctor for any subsequent treatment.
Although doctors hired by employers (or their insurance companies) are supposed to be objective, they often have close and financially rewarding relationships with the employers that refer them cases. Because of this, it’s in your best interest to receive treatment from a doctor you know and trust. Whenever possible, you should choose your own treating physician. Make sure to choose a doctor who is both experienced and articulate. Treating physicians are often called upon to provide written reports or even oral testimony, so it’s important that your doctor can clearly and convincingly explain the reasons behind his or her decisions regarding your care.
In any case, you should 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.
The doctor who ends up treating you will play an essential role in your workers’ compensation case. Your treating doctor will make important decisions about your care, including:
These decisions will have a large impact on what treatment you receive and what benefits you are entitled to. For example, if your doctor says you’ve reached maximum medical improvement, this means that your condition has plateaued to the point where further medical treatment isn’t helpful. It also means that you’re no longer entitled to temporary disability benefits.
In addition, the degree of permanent disability your doctor believes you have will help dictate the amount of permanent disability benefits you receive. (For more information on the types of benefits you can receive, see Nolo’s article Types of Workers’ Compensation Benefits.)
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 (injuries that don’t involve bones), which often cannot be verified through medical imaging devices such as 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:
Be honest and accurate. Describe your symptoms to your doctor truthfully. Don’t exaggerate, but don’t downplay your symptoms either. An experienced doctor will know when you’re not telling the truth, and you’ll lose credibility.
Err on the side of inclusion. Tell your doctor about all of your symptoms, even ones that seem minor or fleeting. Your doctor is the expert, and you should let him or her decide what’s important. Besides, a symptom that seems insignificant now may develop into a serious problem weeks or months down the road.
Don’t speculate. If you don’t know the answer to a question your doctor asks, just say so. Never guess about what the cause of your injuries might be, and don’t say that you have fully recovered unless you’re sure that’s the case.
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 claim is denied, you can pay for your own bills and seek reimbursement from the workers' comp insurance company once the denial is overturned. (For more information, read Nolo's article on appealing a denied workers' comp claim.) Or, 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’ compensation claims can be difficult to navigate, especially if your employer is fighting any portion of your claim. Getting the help of an experienced workers’ compensation attorney can be invaluable in making sure you’re fully compensated for your loss. To find an experienced workers’ compensation attorney in your state, fill out our free case evaluation form.