After being injured on the job, you are probably full of questions, such as can I see my own doctor while on workers’ compensation? Many people feel more comfortable getting evaluated by their own doctor, or they may have a preference for which facility they receive treatment from.
However, the workers’ compensation insurance requirements for most states require that the injured employee visit a medical facility and provider selected by the employer, who accepts the employer’s worker’s compensation insurance policy.
What to Expect from a Workers’ Compensation Doctors Visit
Can I see my own doctor while on workers’ compensation? No — not at first. After you are injured, you are required to see a doctor or urgent care center approved by your employer. The initial exam determines the extent of your injuries. Your employer covers this initial exam. However, if you go to your primary care provider after you were hurt or developed a workplace illness or other medical condition, then the employer is not required to cover the visit.
If you were hurt badly enough that you must go to the emergency room, tell the triage nurse that you received your injuries at work. And then ask that it be reflected in your medical records from the hospital visit so that the doctor notes that your treatment is for a workplace-related injury.
Are There Restrictions to What Workers’ Comp Care Will Cover?
Yes, there are several restrictions to what workers’ comp care will cover. Each employer’s coverage will vary. However, the federal government mandates workers’ compensation insurance guidelines, so most coverage is fairly similar. Just as “can I see my own doctor while on workers’ compensation?” is a frequently asked question, so is “what will be paid for by the employer?”
All medical treatment directly related to your workplace injury or illness you developed in the course of your job should be covered as long as you see the providers approved by your employer. This includes any special care needed to recover, such as an orthopedic surgeon or physical therapy. If you are not satisfied with your medical care, you may request a provider change.
If your employer or their workers’ comp insurer won’t approve the switch, you have the right to appeal the decision with your state’s workers’ compensation commission. Suppose your claim gets to the point where you need to appeal it before the workers’ compensation commission panel. In that case, it may be in your best interests to consult with an experienced workers’ comp lawyer, one who understands the laws and regulations in your state and how to properly draft and argue your appeal before the board.
So How Can You See Your Own Doctor While on Workers’ Compensation?
You have the right to seek medical treatment from wherever you see fit. However, your employer and their insurance company may not reimburse you or your doctor for your case, so you will have to pay those costs out of pocket.
If you try to use your own health insurance to pay for a workplace injury, your own carrier may deny the claim. Most insurance companies expect people to use their employer workers’ compensation benefits, not their own insurance.
You 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 respiratory disease, than for people who got hurt while working on the premises.
If your employer denies your initial claim, and you have to seek coverage from your own doctor and pay for it yourself, then the hearing could resolve in your favor, and you will be reimbursed for your costs.
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 directives: avoiding certain activities, going to physical therapy, completing exercises on your own, and wearing medical gear to help heal, such as a brace.
The treating physician directs your medical care and recovery and performs many duties, including the following:
- 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, you and your workers’ compensation attorney can also appeal this.
Your Rights Under Workers’ Compensation Law
Although you may not have gotten the answer you wanted to the question: Can I see my own doctor while on workers’ compensation, you still have many other rights and choices under federal workers’ compensation law:
- 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
If you’ve been injured on the job and are having trouble with your workers’ compensation claim or obtaining the coverage you are entitled to, we can help. The Joel Bieber Firm is a legal team experienced in handling workers’ comp cases in many different states. Contact us today for a free case evaluation.