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Medical Providers

Do I Have to Go to the Doctor My Employer Chooses?
You only have to go to the doctor your employer chooses for the first visit. Specifically, if an employer or insurance carrier has notified the injured worker of a “preferred provider organization” (PPO), the worker must go there for the first medical treatment; otherwise, the worker may be liable for part of the initial treatment cost. But after the first visit, the injured worker can obtain treatment from the medical provider of his or her choice by using their one time change of medical provider option. If the employer or insurer has not notified the worker of a PPO, the worker can obtain initial medical treatment from the provider of his or her choice. The worker can also change doctors by getting a referral from the treating doctor and retain the one time change of medical provider option for later, if necessary.
I Want to See a Different Doctor. Can I Pick my Doctor?
An injured worker has a right to change medical providers one time. The injured worker must notify the workers’ compensation insurance carrier of the change. A referral from one medical provider to another is not considered a change of medical providers.
My Adjuster Wants Me to See a Different Doctor. Do I Have To?
Yes and No. Your workers comp carrier can request to have you see a different doctor of their choice. This is usually for an IME exam. As for your treating physician, you can select whomever you like, but the insurer may dispute the choice and refuse to pay for treatment from that doctor. This is where you would have a dispute that may be resolved in front of an administrative law judge. Typically, most insurance carriers are willing to have you continue treatment with your personal physician or specialist as long as the choice is reasonable. When you are first injured, you must go to the doctor that your employer or insurance carrier has designated in their workers compensation policy at work, but then you are free to go to your choice of doctor. Any referral to a new doctor is also covered as long as it is related and reasonable. You also have a one-time opportunity to change the doctor of your choice under workers comp. When in doubt, ask your adjuster if you can see a certain doctor. The adjuster is likely to work with you to get the best treatment possible so you can get back to work. If your adjuster refuses to allow you to switch, ask the current doctor to give you a referral. This will get you to the doctor of your choice without using your one-time change of doctor option. If you are unable to get a referral, and/or your adjuster refuses to allow you to see the doctor of your choosing, you always have the right to seek medical care wherever you choose—you may have to pay for it yourself—but you can go where you please. Sometimes, this is the only way to get well and may need to be considered if all other options have failed. This is a reason some cases are better to settle rather than prolong the process. A quick settlement may get you the treatment you need faster, so as to limit the long-term damage of not being treated. It is wise to consult with your attorney to see if this is an option in your case.
If Workers’ Comp Is Denied, Can My Healthcare Insurance Pay for My Work Injury Treatment?
Yes, healthcare insurance can pay for your work injury treatment. When your workers comp claim has been denied, then your personal insurance carrier should cover your treatment of your injuries. The problem with this is that there is no chance for recovery of missed wages, and/or any compensation for the permanent nature of any injury you may sustain. Sometimes having your personal insurance cover the medical treatment is the best way to get well sooner, but you should pursue a work injury as a workers comp claim in order to secure the additional benefits from the workers comp insurance carrier. A conversation with your attorney may help you see the best course to pursue.

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