Can I See My Own Doctor for a Workers' Comp Claim?

If you get hurt at work, you may prefer to see your own doctor. Your doctor knows the most about your health and medical conditions. Applying for workers’ compensation insurance may limit your choice of healthcare providers.

State laws vary as to whether you can use your personal physician or a company doctor after a workplace injury. In some cases, you must use a company doctor first, but can request your own doctor later. We’ll review the three most common state systems and discuss other ways to choose a doctor after a work-related injury.

State Systems for Choosing Doctors

Workers’ compensation billing is done through the state workers’ comp board. This is one reason why insurance companies require injured workers to see approved doctors. It helps ensure that all billing follows state regulations. In some states, you retain the right to change doctors or get second opinions.

Regardless of where you live, you’ll need to see a doctor as soon as possible after a work-related injury and report it to your employer within a certain time frame, usually 30 or 60 days. You must also notify the treating physician of the work-related injury. If you receive emergency care, follow up with one of these doctors, as required by your state’s laws.

You may be able to choose from three different systems. Let’s take a closer look at each one:

Employer/Insurer Choice

In this system, your employer has a list of doctors or urgent care centers that will treat you after an injury. You must see a doctor or medical provider on this list for a diagnosis and initial treatment. This doctor begins the process of filing your workers’ compensation benefits.

You may be able to change doctors after the initial period (30 or 90 days). Some states permit you to request another doctor if your employer is not using a certified Medical Provider Network (MPN), or if you are not receiving adequate care at the treating doctor’s office. Consult a workers’ compensation attorney if you want to change doctors after the first 30 days.

Free Choice System

Some states give employees the right to choose their own doctors from the beginning. In most cases, you must predesignate your doctor before you are injured. When you sign your employment agreement or healthcare paperwork, you will be asked to designate your preferred doctor if you are injured on the job.

If you can choose your own doctor, the doctor must agree to follow state workers’ compensation treatment guidelines and billing regulations when treating you for a workplace injury. Most physicians know these requirements.

Medical Provider Network (MPN) System

An MPN is similar to a private health insurance PPO or HMO. You can choose physicians within a network of approved doctors and specialists in your state. The advantage of this system is that you can more easily transfer to a different doctor within the MPN if you are not satisfied with the initial doctor.

If You Disagree With the Company Doctor

You may not always agree with your doctor or with the prescribed medical treatment. In states where you can’t readily choose your own doctor, you still have some options. You may want to discuss your alternatives with a workers’ compensation attorney. Your options can include:

• Talk to the doctor: Sometimes direct communication is the best route. Remember, workers’ compensation is meant to get you back to work as soon as possible. If your treatment plan seems too aggressive or not focused on your health, ask your doctor to explain.
• Ask for a second opinion: In most cases, you have a legal right to a second opinion. Your state may have procedures for requesting one, such as contacting the workers’ compensation board.

If there’s a dispute, the insurance carrier may request an Independent Medical Examination (IME). This review of your entire claim determines whether your injury was work-related and includes an unbiased medical reexamination of your case.

Your health should always be your primary concern. If you disagree with the doctor, you can seek another opinion. Before doing so, consider getting legal advice from a workers’ comp attorney.

What Happens if I See My Own Doctor Instead?

If you decide to see your own doctor before filing a workers’ comp claim, the workers’ comp insurance company likely won’t pay the medical bills. Workers’ comp payments are structured by the state and include not just your medical expenses but also partial wage replacement.

Seeing your own doctor without pre-designation or other approval can leave you paying the entire cost of your medical care and could jeopardize your entire workers’ compensation claim. You could face not only paying your own medical bills, but also being required to repay any wages you were paid.

Get Legal Assistance From a Workers’ Compensation Lawyer

Most workers’ comp claims are routine. You file your claim, see the doctor, and receive treatment. You should contact a workers’ comp attorney if:

• The company doctor seems biased against you and is minimizing your injuries or ignoring your symptoms
• The doctor has released you back to work on full duty, but you feel you need work restrictions or should not be working yet
• Your request to switch doctors or a second opinion was denied or ignored
• The doctor’s requests for approval of treatment (physical therapy, MRIs) are being denied by the insurer

Each state has different laws about how workers’ comp claims must be appealed. An attorney knows your state’s rules and laws and files the paperwork on time so you don’t miss essential deadlines. If you are not getting the treatment you need or feel you aren’t being heard, contact a workers’ compensation attorney in your state.