I often hear questions from injured workers dealing with the Virginia Workers Compensation system ask questions like “I don’t like my workers’ compensation doctor. Can I see someone else under my regular health insurance instead?”
Let me warn you folks, this is a slippery slope!
I know, all too well, the stress and inconvenience a work injury can put on a person. Then, it is oftentimes compounded by the fact that the injured worker doesn’t even get to pick their own doctor and they may be stuck with a doctor that they don’t feel comfortable with or trust. Medical treatment is intimate and I can certainly understand the desire to go to another doctor for treatment. After all, you only get this one body! I can understand how this would make sense to an injured worker in the short term; however, the long term is where the real trouble comes in.
Short Term Issues of Seeing Another Doctor
If you do go to another doctor through regular health insurance and he or she does treatment or testing that you wish to pursue, the problem is that the workers’ compensation insurance carrier doesn’t have to pay for it because the workers compensation doctor did not request it and the workers’ compensation insurance carrier did not pre-approve it.
The other problem I see right away for injured workers who seek treatment on their own is now they are terribly confused. Not only about what treatment they should be getting but even about their diagnosis. It is not uncommon for doctors to have conflicting opinions, as medicine is not yet an exact science; especially when you are in the early stages of your treatment and diagnosis.
Long Term Issues of Seeing Another Doctor
In most cases, in order to get any testing or treatment under your regular health insurance you have to disclose if the injury was a work injury or an injury stemming from something else. The health insurance company may be none the wiser at first but once they see that this is a work injury, they may refuse to pay for treatment because they will likely say that workers’ compensation should be paying for treatment and not your regular health insurance. Then, when you ask the workers’ compensation insurance carrier to pay for it, they will probably refuse because you chose to seek treatment outside of their network of medical providers. This means you are now stuck with the bills for expensive medical care because neither insurance company is willing to pay for it!
Some injured workers will try to side-step this whole thing by not listing their current problems/treatment as a work related injury. When they to go back and try get their treatment covered under workers’ compensation insurance this will DESTROY their case (remember documentation is key!).
Every situation is different so, if you have a situation similar to any of the scenarios listed above or if you are contemplating seeking treatment on your own, you should talk to an experienced workers’ compensation attorney who can give you some guidance before you do anything that you might regret.
If you have questions about your benefits or if you would like more information on the Virginia workers’ compensation system, order my book, “The Ultimate Guide to Workers’ Compensation in Virginia” by clicking this link, or call our office today (804) 755-7755.