One of the most common questions after a workplace injury is whether or not an injured employee can see their own doctor while on workers’ compensation. Many people prefer their primary care physician or a familiar treatment facility, but state laws and workers’ comp policies often dictate your options.
Workers compensation requirements for most states often require the injured employee to visit a medical facility and the provider be selected by the employer’s insurance, one that will accept the employer’s workers comp insurance policy.
What to Expect from a Workers’ Compensation Doctor Visit
An initial evaluation will take place to determine the severity of the injuries. This will play a significant role in your workers’ compensation claim; however, different states have different laws about doctors’ choice.
What the Law Says About Doctor Choice
North Carolina
North Carolina’s Workers’ Compensation Act § 97-25 mandates that the employer or their insurer initially controls the selection of medical providers. However, employees can request a change of physician through the North Carolina Industrial Commission.
South Carolina
South Carolina law (S.C. Code § 42-15-60) requires injured workers to receive treatment from a provider chosen by their employer. Any unauthorized medical treatment may not be reimbursed.
What Medical Treatment Does Workers’ Compensation Cover, and Are There Restrictions?
Workers’ compensation generally covers medical treatments directly related to a workplace injury or illness, as mandated by federal regulations (such as those outlined by the Occupational Safety and Health Administration). This includes emergency room visits, surgeries, physical therapy, and specialized care like treatment from an orthopedic surgeon or rehabilitation services. Prescription medications, medical equipment, and travel expenses for medical treatment may also be covered under your plan.
Coverage, however, is not the same across all employers or states. Treatment from providers must be approved by their employer or the workers’ compensation insurance carrier. Unauthorized medical visits, even for valid work-related injuries, may not be reimbursed. If an employee is dissatisfied with their care, they can request a change in provider, but approval depends on your employer or the insurer. Denied requests can be appealed through their state’s workers’ compensation commission.
Understanding what is covered is essential for receiving the appropriate treatment. State-specific regulations often influence the scope of benefits. For example, emergency room visits and specialized therapies are widely covered, but additional services like travel reimbursement or alternative treatments may vary. To navigate these nuances, consult one of our workers’ compensation attorneys. An experienced lawyer is just a phone call away, ready to help you appeal denied claims, change a provider and ensure everyone receives the benefits and care they are entitled to.
Mileage Reimbursement for Doctor’s Appointments
In many states, workers’ compensation will reimburse injured workers for mileage expenses related to doctor’s appointments. This includes travel to and from doctor’s appointments, physical therapy sessions, and other medical treatments.
For North Carolina residents, a mileage reimbursement will apply for any distance greater than 20 miles round trip. For South Carolina residents, you are entitled to mileage reimbursement for any distance greater than 10 miles round trip. You may be entitled for a reimbursement for other reasons in South Carolina as well. Consult your Worker’s Compensation attorney to see what other trips are eligible for reimbursements.
To Be Eligible for Mileage Reimbursement:
-Keep a record of their mileage expenses, including details such as the date, time, and distance traveled.
-Keep all receipts and record any expenses related to travel. Gas, tolls, and other expenses all may be needed to be shown.
-Check in with your workers’ compensation attorney to determine the specific mileage reimbursement rate in your state.
How to See Your Own Doctor While on Workers’ Compensation?
Navigating a workers comp claim can be challenging, especially when an employee is seeking approval to see their own doctor.
They have the right to seek medical treatment from wherever you see fit. However, they may have to pay out of pocket as their employer and their insurance company may not reimburse an employee or their doctor for the case.
An employee’s own carrier may also deny the claim if they try to use their own health insurance to pay for a workplace injury. Most insurance companies expect people to use their employer workers’ compensation benefits, not their own insurance.
If necessary, an employee may be able to appeal this decision with the workers’ compensation board if the employer denies your initial request for coverage. This is more common for people who have developed an illness or chronic medical condition due to their working environments (such as carpal tunnel syndrome or a respiratory disease) than for people who got hurt while working on the premises.
Can I Request a Different Doctor for My Workers’ Comp Treatment?
In some cases, injured workers may be able to request a different doctor for their workers’ compensation treatment. This may be necessary if the injured worker is not satisfied with the care they are receiving from their current doctor or if they need specialized treatment that their current doctor cannot provide.
If an employee is dissatisfied with their treatment, most states allow them to request a different doctor.
To request a different doctor, injured workers typically need to submit a request in writing to their employer or the insurance company handling their workers’ compensation claim. Documentation may also be necessary from their current doctor explaining why a different doctor is needed.
It’s essential to note that the insurance company or employer may not always approve a request for a different doctor. Consult with one of our workers’ compensation attorneys if you are having trouble getting approval for a different doctor.
The Importance of Your Workers’ Compensation Treating Physician
The doctor you first see for workplace injury is your treating physician. To continue having your medical care covered, you must comply with their instructions: avoid certain activities, go to physical therapy, complete exercises on your own, and medical gear to help heal.
The treating physician is in charge of your medical care and recovery and performs duties, such as:
- Providing referrals to specialist providers
- Authorizing medical leave from work
- Establishing work restrictions, such as light duty or part-time hours
- Clearing you to go back to your full job duties
- Determining if any of your injuries resulted in permanent damage or limitations
For your employer’s benefits to cover any special care or therapy, your treating physician must provide a referral, deeming it medically necessary. If the employer’s insurance carrier denies these recommendations, an employee will need to appeal.
Emergency Medical Situations and Workers Compensation
Emergency medical situations can arise at any time, sometimes requiring immediate medical attention. In these situations, workers’ compensation will typically cover the cost of emergency medical care, including emergency room visits and hospital stays.
Does Workers’ Comp Pay for Emergency Room Visits?
Yes, workers’ compensation will typically pay for emergency room visits related to a work-related injury or illness. Injured workers should inform the emergency room staff that they are seeking treatment for a work-related injury or illness, and they should provide their employer’s contact information and workers’ compensation insurance information.
Workers’ compensation will typically cover the cost of emergency medical care, such as:
- The Initial emergency room visit
- Hospital stays
- Surgeries
- Prescription medications
- Medical equipment
Injured workers should keep a record of their emergency medical expenses, including receipts and medical records. They should also notify their employer and the insurance company handling their workers’ compensation claim as soon as possible.
It’s essential to note that laws vary from state to state, and the specific rules and regulations regarding emergency medical situations may differ.
What Workers’ Compensation Rights Do You Have?
You have:
- The right to your full medical records from the injury
- The right to ask questions about what is and is not included in the medical record
- The right to refuse any treatment if you do not feel comfortable with it
- The right to consent to any recommended treatment
- The right to get a second opinion if you are dissatisfied with your current treatment plan
- The right to file an appeal for your coverage or choice of provider with your state’s workers’ compensation commission
- The right to have an attorney represent you before the workers’ comp board
- The right to file a lawsuit if you cannot get a resolution in any other manner
Remember, understanding your rights is crucial when dealing with workers compensation claims and ensuring you receive the benefits you are entitled to.
Work With an Experienced Worker’s Compensation Lawyer
If you’ve been injured at work and are facing challenges with your workers’ compensation claim or securing the benefits you deserve, we’re here to assist. The Joel Bieber Firm has a dedicated legal team with extensive experience handling workers’ compensation cases in North and South Carolina. Contact us today for a free case evaluation.