Your Doctor for a Workers’ Comp Case — Who Chooses?

If you are injured at work or fall ill for work-related reasons, you may find yourself asking some of the following questions:

• Do I have to go to the doctor my employer or workers’ comp carrier chooses?
• Is there any way to select my own medical provider for a workers’ comp claim?
• If I find my chosen physician to be unsatisfactory, is it possible to change doctors?

The answers to these questions can vary, depending on your employer’s healthcare provider network. If the option is available, you may be able to designate a personal physician prior to your workers’ comp case.

Employer-Designated Doctors

Utah laws allow employers to choose the doctor you must visit in a workers’ comp case—at least for the first visit. Your employer or insurance carrier may give you a preferred provider organization (PPO) or medical provider network (MPN). If that’s the case, you will need to choose one of their listed doctors for your initial treatment. This is done in part to ensure the healthcare provider understands state guidelines for treating work-related injuries and illnesses. You could risk a denial of workers’ comp coverage if you avoid this first visit without permission. Or at the very least, you will likely have to pay for that initial treatment out of pocket, either partially or fully.

The Initial Doctor Visit

Employers and insurers should choose trusted medical professionals who have experience with workers’ comp claims. These doctors will be able to assess your ailment and determine what further care you’ll need. They will also provide the medical documentation you’ll need for your workers’ compensation claim. However, after that first visit to your employer-designated doctor, you have the option to change your medical provider. This is one-time transfer allowing employees to make the remainder of their recovery with a physician of their choice.

A Doctor of Your Choosing

It is always possible to visit your own doctor in addition to the one you’re required to see following a work injury or illness. But for the sake of workers’ compensation, if you wish to see your preferred physician from the start, you would need to officially predesignate one in writing. Prior to your injury or illness, fill out the proper paperwork and have it approved by your employer or workers’ comp carrier. You may also be able to choose your own doctor in a workers’ comp case right away if your employer does not have a PPO or MPN in place.

Changing Doctors

After your first visit to the employer-designated doctor, you have the right to change physicians. The exact process can vary, but normally you will need to notify the workers’ comp insurance carrier beforehand. There are multiple reasons why employees may choose to see a different doctor for their work-related ailments. It is perhaps most worth considering if you feel your needs aren’t being met, or if you disagree with the doctor’s assessment. Be sure to discuss and document your concerns with the manager of your workers’ comp case.

Note that it is possible your employer-designated doctor will refer you to another physician better-suited to assist you. This prescribed transfer would not count for your personal one-time change of medical providers.

A Second Doctor’s Opinion

In certain cases, you might simply want a second opinion for your diagnosis or your plan for recovery. Utah law allows this, but again, you will need to notify the workers’ comp insurance carrier beforehand. Similarly, in the event there’s dispute regarding the extent or nature of your ailment or your ability to return to work, you may need an Independent Medical Examination (IME). In those circumstances, you would need to see a second doctor chosen by the employer or insurance carrier.

Getting the Health Care You Need

An attorney can assist you in getting the proper medical attention following a work injury or illness. For example, if you don’t agree with the assessment your employer-designated doctor makes, an experienced workers’ comp lawyer can guide you through the process of switching medical providers. Email legal@workcomputah.com for details on how to proceed and to ensure your rights are protected.