Are You Allowed to See Your Personal Doctor for Workers Comp Injuries?

Did you know that the most costly worker’s compensation claim is from amputation and averaged $98,126 per claim filed between 2016 and 2017?

If you recently were injured in your job and are wondering if you are allowed to see a personal doctor for your injuries, you are in the right place. There are a few things you need to know about choosing your own doctor for a worker’s compensation injury.

Keep reading to learn more about worker’s comp injuries and how to go about seeing a doctor.

Seeking Medical Help

Before we dive in, please keep in mind that every state has its own laws regarding worker’s compensation claims. While every state has its own laws every state has one thing in common: if an employee is injured at work they have to be evaluated and diagnosed by a workers compensation doctor that the employer’s insurance company approves.

If the injury is an emergency you typically have the right to seek treatment right away from any doctor or any hospital. If it’s a non-emergency issue do not under any circumstances take it upon yourself to go seek treatment, make sure you always follow the worker’s compensation rules in your state.

Keep in mind there are some states where you can pick your own doctor from the very beginning, but for the most part, most states require you to select from their list of approved Workers’ Compensation Doctor.

Independent Medical Exam

Initially, you have to by law be treated by doctors that are approved by your employer’s insurance company as we mentioned above. Your claim is dependent on the medical opinion of this doctor. If you refuse to have an Independent Medical Exam (IME) by the doctor approved by your company they will deny your claim right away.

The independent medical exam is an exam that many insurance adjusters and employers will send injured workers to have a second opinion. They want to be sure that the claims are true and that they are not going to pay for injuries that are not related to a work injury.

Keep in mind that workers comp insurance companies are in the business to make money and if they can save money by not paying for your medical bills they will do whatever it takes to save money. Sometimes independent medical examiners will say that nothing is wrong and cut off employee’s compensation benefits.

If you are ever told that you have to see an independent medical examiner, find an experienced workman’s comp attorney. An attorney will make sure that your rights are protected during this process and that you are not robbed of rights you deserve and are entitled to. If you have any further questions contact your local IME doctor to get them answered.

What to Expect During the Exam

See if you can have a relative or a friend go with you to the independent medical exam. Although they will not be allowed to speak you can ask them to take notes and be your witness during your visit. Be prepared to have to re-tell the story to the IME doctor of what happened and how you got injured.

The reason the doctor wants to hear it from you is to see if there are any inconsistencies from the files and records they were given. Stick to the facts and do not rush while you are sharing what happened.

With the independent medical exam, you will not have a right to confidentiality – do not forget this. Everything that you say or do, will be reported to the insurance company. Your actions and your words can be used against you to try to deny your benefits.

From the moment you arrive at your appointment, you will be watched. They will even pay attention to things like getting in and out of your vehicle, how quickly you walk in through the door, how you act while you are sitting down, etc. The point is that they will be paying attention to your every move.

Medical History

When they ask about your pre-existing conditions during the exam do not try to conceal any injuries or medical conditions you had before your work injury. If you do have any prior conditions you will have to tell the doctor how this specific work injury is different from your pre-existing conditions.

Share All the Details 

When they ask you how you are feeling that day share every detail about how you are managing your pain. If your injury is affecting your daily activities such as moving around, taking showers or even getting dressed, let them know the truth.

Try your best to not leave anything out no matter how embarrassing it might seem. If you have trouble using the bathroom tell them the truth – no matter what! Do not lie and say you can’t drive and lift if you truly can or have been driving around. Injured workers are typically under surveillance because insurance companies want to make sure they are not being lied to.

If you are seen driving or lifting your kids or groceries and are caught on video, your claim will be denied, no questions asked.

Last but not least make sure you show up to your appointment on time and be courteous to everyone in the office. Even if the front desk staff or the doctor are rude, you should be as polite as possible and never react without thinking before you speak.

After your exam write down everything about the exam while it’s still fresh in your mind. You also have the right to ask for a copy of the IME doctor’s report.

Can I Switch Doctors?

If you ever feel like the doctor you are seeing is more interested in your employer’s financial well being than your recovery you might have the right to change your doctor. Again this varies by state and you want to make sure that you follow the laws in your specific state.

If you feel that your condition is not improving or it’s even regressing then you might also have the right to change doctors at least one time. We always recommend the same thing – make sure you abide by the laws in your state regarding workers’ compensation.

Some states will allow you to change doctors but will limit the number of times you can change physicians. Others will not allow any changes and you might have to hire a lawyer to help you if you really feel you are not being treated fairly.

Is It Possible to Get a Second Opinion?

Although you might not be allowed to change doctors by law, you might be entitled to receive a second opinion in some states. If your state allows you to get a second opinion then this allows you to get a one-time exam by a different doctor who will review your medical records, and recommend a treatment. After this exam, your employer’s insurance company will consider the second opinion and will assess your worker’s comp claim.

If your benefits are ever denied this second opinion can also be used as evidence at a hearing.

Medical Bills

Until a worker’s compensation has been approved your medical bills will not be paid. This means that as soon as you suffer an injury you have to tell your employer as soon as possible. At this time your employer will give you the forms that you have to fill out to get your claim started.

If you have any unpaid bills you can send them to your employer. Make sure that you send unpaid bills via certified mail to have proof that you did mail the bills in case they do not get paid.

Ongoing Treatment

If your injury requires you to have ongoing medical treatment there are states that will allow you to seek treatment from specialists. Although they might allow you to see a specialist for your condition such as naturopaths, chiropractors, therapists, etc they might limit how many visits you can have.

The main thing is to make sure that you are aware of when you are allowed to see a specialist and have it covered under workers’ comp benefits.

Now You Are Educated About Seeing a Personal Doctor After a Work Injury

Now that you know under what circumstances you can see a personal doctor when you are dealing with a worker’s comp injury you can make sure that you do not ruin any benefits you truly are entitled to.

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