What Kind of Doctor Should I See After a Worker’s Comp Accident?

What is Workers’ Compensation?

Workers’ compensation is a type of insurance giving salary replacement and medical benefits to workers hurt during employment in exchange for compulsory renunciation of the worker’s right to take legal action against his or her company for the negligence tort. The dialogue between guaranteed, restricted coverage, and lack of option outside the worker compensation system are recognized as “the compensation bargain.” A problem that the compensation bargain remedied is one of the companies becoming bankrupt because of elevated damage awards. The collective liability system was produced to stop that, and therefore to make sure security of payment to the employees.

While plans vary among jurisdictions, provision can be made for weekly payments instead of earnings, acting in this situation as a type of disability insurance, payment for prior or impending financial loss, repayment or recompense of medical and like costs, acting in this situation as a type of health insurance, and benefits owed to the wards of workers killed in the course of employment.  General damage for pain and suffering and punitive damage for company negligence, are normally inaccessible in workers’ compensation plans, and negligence is normally not a concern in the case.

These laws were initially ratified in Europe and Oceania, with the U.S. following soon afterward. In the U.S, some type of workers’ compensation usually is obligatory in many states, conditional on the organization’s features, with the significant exclusion of Texas as of 2018. Despite being required, businesses might buy insurance voluntarily, and in the U.S., policies typically consist of obligatory coverage (Part I) and non-obligatory coverage (Part II).

Workers’ compensation includes all sensible and required medical treatment for an occupational injury or sickness. This consists of appointments with doctors, surgeries, physical therapy, medicines, and other treatment. The physician who cares for your work injury will be an imperative factor in your case—not just by supervising all your medical care, but also providing opinions that will influence how much you get in workers’ comp benefits. For these purposes, it is imperative to locate a treating doctor you can count on. However, that search could be complicated by your state’s restrictions on physician choice.

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

The regulations for receiving medical treatment using workers’ compensation differ among states. If you do not adhere to the regulations of your state, the insurance company might decline to fund your treatment. Every state permits you to obtain the closest accessible emergency care when that is required. Outside that, however, your decision of a treating doctor might be restricted, conditional on where you reside and who your company is.

In addition, the regulations are frequently complex, but your liberty to select usually falls into one of three groups: (1) you choose a physician from a list or medical network given by your company; (2) you choose any approved physician; or (3) your company selects the treating doctor for you.

Provider Networks or Panels for Workers’ Comp Treatment

In most states, companies have the choice of signing with a chosen provider plan, network, or managed care organization to care for the work injuries of their workers. This is a gradually standard method for companies and insurance companies to decrease costs and regulate medical care for workers’ comp cases. If your company has a plan such as this, you must choose a treating doctor from within the network and adhere to its regulations for obtaining medical care.

Specific states permit companies to give injured employees with a list or panel of physicians to select from. These lists typically must include a minimum number of physicians and specialists; frequently, there are restrictions of the number of work-related clinics that might be added.

Employee Chooses the Treating Doctor

In a few states—such as New York, Texas, and Illinois—you have the right to select your treating doctor, providing your company does not have a provider plan or managed care agreement. Normally, however, you must select from a list of health care providers that the state has sanctioned for caring for workers’ comp injuries.

There might be additional criteria for selecting your physician. For instance, in California, you might utilize your primary care doctor as your treating doctor, but only if you have presented your company with written notice before the injury that you wish to do that; besides, this alternative is only accessible if your company presents group health coverage.

Company Chooses the Treating Doctor

Still, in other states, you must visit a treating doctor selected by your company, at least initially. A few of these states only demand you to visit the company physician for your first visit, as in Florida, or for a specific period before you switching doctors.

Workers sometimes agonize that a company-chosen physician has a conflict of interest and may lessen their injuries. Regrettably, this could be accurate in your case. You could change physicians if you think that you are not obtaining proper care. However, you must adhere to the regulations in your state for switching workers’ compensation physicians.

Suggestions on Locating the Correct Treating Doctor

You ought to do whatever you can to locate the finest treating doctor for you, even though you are restricted to a network or a list of doctors. When you are dealing with prospective physicians or their offices, think about their:

  • Skill and knowledge of your medical condition
  • Eagerness to consent to the workers’ comp medical payment schedule
  • Understanding of the workers’ compensation claim process
  • Eagerness to maintain your workers’ comp claim with thorough reports, and
  • Being accessible for medical appointments.

Primarily, you ought to select a physician that you count on and feel at ease with. If you require assistance locating a treating doctor, a workers’ comp attorney might have a few suggestions. Also, a lawyer can clarify the regulations in your state and assist you if you wish to switch treating doctors or are having difficulty obtaining appropriate medical care.