Can I pick my own doctor to treat me during my workers’ compensation case?
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Video Transcript

People ask me if they have to use the workers comp doctor or can pick a different doctor to get treatment for their injuries.

Unfortunately, the short answer is you must use the workers comp doctor; the insurance company picks three doctors that they have a relationship with, and then you pick one of those three doctors to treat you for your injuries.

So, it’s in your best interest to stay with that doctor to maximize your benefits.

If you decide to use your own doctor, there are consequences.

One, the workers comp insurance company will not pay for any of the medical care. You will be paying your deductible and co pays at a minimum.

The worst case scenario is that your regular insurance pays for your care and then down the road, they discover that this should have been covered by workers compensation. They will then bill you for the entire amount that they have paid the doctors.

Two , the workers comp insurance company is most likely not going to listen to what your doctor has to say about your treatment plan or your ability to work, so you wouldn’t be getting your lost wage check. You would need to go to a hearing to force them to abide by your doctor’s out of work disability slip.

However there is an exception.

When the medical portion of your workers comp claim is denied, you get to pick your own doctor. You’ll be using your own health insurance and you won’t be getting reimbursed until you go to a hearing and receive a medical award. But thereafter, the workers comp insurance company has to continue to pay for your doctor’s treatment.

As an experienced workers’ comp attorney, I can help injured workers to pick from a panel of doctors if their care is being paid for, or if their case is denied, I can help them find a good doctor who will treat their injuries.

How Do I Change My Doctor After I Receive Workers’ Compensation?

If you are hurt on the job, your employer is required to give you a list of three approved doctors from whom you may seek treatment. Once you have chosen one of the three, you are required to continue seeing them in order to receive your workers’ compensation benefits.

If you would like to change your doctor, it must be approved by your employer or insurance carrier before you make such a change and seek treatment with the new doctor. If your employer or insurer does not approve the change, you may petition the Virginia Workers’ Compensation Commission, who may approve the change.

The Commission may approve the change if you can prove that: 

  • your condition requires a specialist;
  • you are receiving inadequate treatment;
  • your health is not improving or unconventional treatments used by the original doctor are not working;
  • your doctor is not cooperating with orders given by the Commission; and
  • there is no treatment plan for any long-term disabilities from which you may be suffering.

If you are planning to change the treating doctor in your workers’ compensation case, it is best to contact a work injury lawyer in Richmond, VA to ensure you are taking the appropriate legal steps and that you have the proper evidence and proof ready for a Commission hearing, if such a hearing is required.

How to Best Deal with Doctors Who Treat You for Your Injury

I cannot stress enough the importance of the role of your workers’ compensation treating physician in your case. Besides the fact he will be one who will be taking care of your physical needs, his opinions will decide the legal consequences of your workers’ compensation claim. Therefore, it’s very important to have a good relationship with your workers’ compensation treating physician even if this physician has been chosen by the insurance company. Since your workers’ compensation treating physician’s opinion is given great weight when an issue arises about what caused a medical problem or if a particular treatment may be reasonable and necessary, his opinion is very important.

Here are some tips when dealing with your doctor:

1. Describe the work accident specifically on the first visit to the doctor. One of the worst mistakes that an injured worker can make is not to describe in detail on his or her first visit to the doctor the facts of the accident. It is difficult to prove that you had an injury by accident if in the first doctor’s visit there are no notes in the history section as to how the injury occurred. Therefore, it is very important to state to the doctor where you were and what occurred. Then in his notes in the history section (which is in all medical notes) it will state “slipped and fell at work” or “lifted a box at work.”

2. There is no doctor/patient privilege. You need to understand that there is no doctor/patient privilege in workers’ compensation. Thus, all your medical records will be read by the insurance adjuster and can also be read by the insurance defense attorney and the Virginia Workers’ Compensation Commission. Therefore, it’s also important not to make statements to the doctor that you would not want other individuals to know. Of course, be truthful with your doctor so he can treat you as effectively as possible but avoid getting into arguments with your physician or rambling about non-work related medical conditions unless you do not mind the insurance company knowing.

3. Talk to your doctor about your work restrictions. If at all possible, try to get the doctor to discuss with you his opinion about your return to work restrictions, your functional capacity, and anything related to your ability to return to work before he gives them to the insurance company. Many times, a nurse case manager may try to unfairly influence the doctor’s opinion with regard to these issues. Thus, if you bring up this issue with your doctor first, you would at least have an opportunity to present your views to the doctor on an equal basis with the nurse case manager.

4. Always mention all body parts that were injured. Every time, especially the first time, you go to the doctor it is important that you reiterate every body part that has been injured as a result of the work accident. If a body part is not mentioned, it will be cause for the insurance company to deny treatment in the future for that injury. Many insurance adjusters will deny medical treatment for a body part not mentioned in the first appointment. I have had to help injured workers get medical treatment for serious injuries to the neck that did not get mentioned until the second doctor visit because the pain in the shoulder was so severe that the neck problem didn’t seem that important. Therefore, if you have one area that hurts really badly and one area that hurts a little bit, you still need to tell the doctor about both.

5. Always get a disability slip from your doctor. Before you leave your doctor’s office, always get a disability slip. The workers’ compensation insurance company is not going to pay you a weekly check unless they have a copy of a disability slip that says you are not able to work or your work restrictions are such that your employer cannot accommodate the restrictions.

6. Talking with your doctor about lawsuits or a lawyer’s advice: A doctor’s job is to focus on your medical condition. In order to do that job, a doctor does not have to know about your workers compensation claim or your lawyer. Sharing your legal issues or concerns with a medical care provider should be unnecessary. Most doctors do not want to be involved in a lawsuit. Remember that whatever you say in confidence to a doctor is not confidential at all in a workers compensation claim. Insurance companies and the Virginia Workers Compensation Commission get to see your medical records.

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 (866) 608-5893.