Who Chooses the Doctor for Workers’ Compensation Claims?

After a workplace injury occurs, you may have a lot of questions. Do you have access to workers’ compensation? If you do, how do you go about getting treated? And if you get treated, who treats you? The answers to these questions will depend on the state in which you live and the kind of business employing you. For our purposes, we will focus primarily on the question of choosing a physician. First, we will briefly address some initial questions.

Preliminary Considerations

Before figuring out who selects your physician, you want to make sure you’re entitled to workers’ compensation. You can usually ask someone in human resources or check in with your state’s workers’ compensation office. You may be entitled to coverage for workplace injuries, even if your employer lacks workers’ compensation benefits. This is because state law can sometimes require employers to have this form of coverage. If so, you should seek out the assistance of a legal professional with experience in these cases.  

As Johnson observes, you should also make sure you’re technically employed by the company for which you work. To that end, you may want to check out the Department of Labor’s criteria for what constitutes an “employment relationship.” And of course, you should be certain that your injury occurred while on the job. In that regard, it’s a good idea to report your injury as soon as it happens, even if you feel like you aren’t in need of medical assistance. Any delay could work against your ability to collect workers’ comp.

Choosing a Doctor

Once you’ve determined if you’re eligible for workers’ compensation, you will probably be interested to learn how you go about getting treated. Specifically, you may want to figure out which party has the right to choose the physician. As mentioned, every state has its own statutes governing this decision.

In some states the worker may choose the physician from a predetermined network. That network, in some cases, will have already been formed by the state, the employer or an insurance company. In other cases, the employer can decide which physician will conduct the treatment. And still in other cases, state law may differentiate between who chooses the initial physician and who chooses the long-term care doctor.

California

In California, for instance, you can predesignate your physician if you already have healthcare

that covers injuries occurring outside of worktime. If you fail to name a physician in writing prior to the injury, the employer may then choose the doctor. In California, there are different forms for predesignation, depending on whether your employer has a relationship with a Health Care Organization (HCO).

Delaware and Colorado

In Delaware, the employee is entitled to choose his or her own doctor. In Colorado employers may select the physician, but in order to do so, they must provide a list of four potential doctors. If the employer fails to adequately supply the injured employee with choices, the worker may then choose a physician.

Illinois

As explained by Ronald B. Sklare, Illinois allows employees to see two doctors. One of those doctors must be chosen by the employer, but the other physician may be selected by you. If the two doctors differ in their opinion, there are two possible outcomes. You may seek to settle the dispute with an arbitrator. You may also opt to have the employer assemble an independent examination to determine your capacity to work.

To learn more about workers compensation in your state, check out the National Federation of Independent Business’ website.

Federal Statute

If you happen to be a federal employee, the relevant statute is the Federal Employees’ Compensation Act (FECA). Under the FECA, you have the right to select your physician and may choose from any locally available hospital or doctors’ office. However, it should be noted, following the initial visit, if more treatment is needed, you must check in with the Office of Workers’ Compensation Programs (OWCP) before continuing to see a physician. If you fail to do so, the OWCP may no longer take responsibility for the work-related injury and associated costs.

If you feel you are not getting treated equitably by your employer, it’s probably a good idea to consult an attorney who has a good deal of experience in this area. He or she can help point you in the right direction and potentially save you money (and trouble).