Finding a Treating Doctor in Your Workers' Compensation Case

Employees must follow state rules when seeking medical treatment for a work injury.

Workers’ compensation covers all reasonable and necessary medical treatment for a work-related injury or illness. This includes doctors’ appointments, surgeries, physical therapy, medications, and other treatment. Your treating physician will oversee all of your medical care, including referring you to specialists and assigning work restrictions. And, your doctor’s opinion about your injuries will determine how much you receive in benefits. For these reasons, it is important to find a treating doctor whom you trust.

Workers’ compensation laws vary from state to state. It is important to follow your state’s rules and procedures for getting medical treatment. If you don’t, the insurance company may refuse to pay for your treatment.

Who Chooses the Treating Doctor in a Workers’ Comp Claim?

When you’re injured at work, you should report your injury to your employer as quickly as possible. You should also get medical treatment right away. The rules for getting treatment through workers’ comp depend on what state you live in. You may be able to choose your own doctor, or your employer (or its insurance company) may send you to its occupational doctor or clinic.

Employee Selects the Treating Doctor

Some states—including Illinois, New York, and Washington—allow workers to control their medical care. In these states, you may select any physician that accepts the workers’ compensation billing schedule. (Because there are usually limits on how much a doctor can charge in a workers’ comp case, some doctors won’t treat work injuries.) In some states, you may be required to treat with an M.D. or D.O. In other states, chiropractors and naturopathic doctors may be permitted to be treating physicians. Make sure you follow your state’s rules and properly notify your employer or its insurance company.

In some states, such as California, workers can only treat with their own doctor if they “predesignated” before the work injury. To predesignate, you must complete a form naming your primary care doctor as your treating doctor in the event that you suffer a work injury. This option is only available in California if your employer offers group health coverage. (To learn more, read our article on California rules on choosing a workers' comp doctor.)

Employer Selects the Treating Doctor

In other states, the employer gets to choose the initial treating doctor (except for emergency treatment). Some states require you to see the company doctor just for your initial visit or for a certain period of time before you change physicians. For example, you must treat with the insurance company’s doctor for the first 28 days in Michigan In Pennsylvania, you must see the company doctor for 90 days. In other states (including New Jersey and South Carolina), the employer has the right to select your treating doctor for the life of your workers’ comp claim.

Sometimes, workers worry that a company-selected doctor has a conflict of interest and might minimize their injuries. This, unfortunately, has been known to happen. However, you may be able to switch doctors if you believe you are not getting adequate care. Each state has different rules for changing workers’ compensation doctors, though, including notifying the insurance company beforehand. If you do not follow the correct rules, the insurance company may refuse to pay your new doctor’s bills.

Employee Chooses From a Panel or Network Established By the Employer

In some states—including Georgia, Pennsylvania, and Virginia—the employer presents the employee with a list (or panel) of doctors to choose from. The panel will generally include the names of several doctors who are authorized to treat your work injury. Some states require employers to include at least one specialist and one minority doctor on the panel.

In other states, employers are permitted to establish a managed care organization (MCO) or other provider network for injured workers. This is an increasingly popular way for employers and insurance companies to reduce costs and control medical care. Typically, once you select a doctor from a network, he or she becomes your treating doctor. MCO rules can be complicated. If you need help understanding your rights, speak with an experienced workers’ comp lawyer or your state workers’ compensation agency.

Tips on Finding the Right Treating Doctor

If you are able to choose your own doctor, it is important to find the right physician. A good doctor-patient relationship may lead to a quicker recovery and reduce the likelihood of a claim denial. When selecting a treating doctor, consider his or her:

  • experience and understanding of your medical condition
  • willingness to accept the workers’ comp medical fee schedule
  • knowledge of the workers’ compensation claim process
  • willingness to support your workers’ comp claim, and
  • availability for medical appointments.

Above all, you should choose a doctor whom you feel comfortable with and trust. If you need help finding a treating physician, a workers’ comp lawyer may have some recommendations. (For more tips, see our article on getting medical treatment through workers' comp.)

Additionally, it is important to give your doctor accurate information about your injury and symptoms. This will help your doctor understand your condition and provide the best possible medical treatment. Your treating doctor’s medical records are an important part of your workers’ comp claim. Both the insurance company and workers’ comp judges use these records to determine your eligibility for benefits.

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