Workers Comp Doctors: What You Need To Know

If you have suffered a work related injury of any sort, from a back injury to carpal tunnel to any other career or workplace related injury, and need medical treatment, chances are you filed a worker compensation claim. Once your claim has been accepted, your medical treatment option may be limited depending on your employer’s worker compensation insurance company. Most independent insurance companies have their own guidelines or procedures for approving medical care reimbursement for accepted claimants. Some of the rules may dictate you visit special workers comp doctors for your care.

Who Determines Your Care Provider

The rules for determination of who provides your care differ from state to state, as the state compensation law where you live may entitle the insurance company to determine where you will receive your treatment for injuries. State laws often try to protect insurance companies and taxpayers from increased costs due to fraudulent claims by letting the insurance company establish a lasting relationship with a reputable care provider.

In other areas, state law might dictate that the injured worker decide what care provider he or she will seek treatment from. If there is any dispute between the injured worker and the insurance company however, the final decision regarding who is allowed to be the care provider will rest in the hands of the State Industrial Commission.

Your IME (Independent Medical Examination)

Often considered by the insurance company as a crucial point in the claim process, your IME will be used specifically to decide the final formula for your total offer of compensation from the insurance provider.

At this examination, you must be extremely clear with your doctor about any and all symptoms you are experiencing due to your work related injury.
Pay close attention to how this doctor perceives what you say, as the diagnosis your doctor gives the insurance company is directly related to your amount of compensation.
Ask questions, and take notes of all doctor recommendations.

If the Insurance Company Decides Your Care Provider

You are entitled to certain protections regarding your care and treatment options when your insurance company decides your care provider. For instance, in some states the injured worker must only see the appointed physician for a period of 90 days. Any care needed after that can be given by the injured worker’s regular doctor. This regulation is not in place in every state, so any injured worker should speak with a professional compensation consultant to discuss care options.

No matter what state the injury occurred in, the worker has the right to object to any decision made by the insurance provider regarding workers comp doctors and to request a different doctor. No insurance company anywhere is allowed to deny you the right to acquire a second opinion from a doctor of your own choice.

Getting Help

If you are having problems getting your workers comp benefits or you do not like your workers comp doctor, consult with an experienced attorney as soon as possible. Your lawyer can help you to ensure you get all the care you need to get over your injuries, and that the care is covered by workers comp.

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