Do I Have to See the Insurance Company Doctor for my Workers’ Comp Case?

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Can I choose which doctor treats me after my workplace injury?

There’s no single, straightforward answer to that question. Generally, your employer’s insurance company will dictate which doctors you see when you have an accepted workers’ compensation claim. While you may prefer to see your family physician or another doctor of your choosing, this isn’t always possible.

If you’ve been injured on the job, it is your employer’s legal responsibility to provide medical treatment. That also means the employer’s insurance company can send you to a qualified doctor of their choosing for treatment. You can ask N.C. Industrial Commission for permission to see a different doctor or get a second opinion, but the rules for changing doctors are very strict. Recent legislation has made the process of switching doctors even more complicated.

The insurance company has the right to choose your workers’ compensation doctor except in these circumstances:

  • You require emergency medical treatment.
  • Your employer refuses to send you to a doctor.
  • The insurance company denies your workers’ compensation claim.
  • The Industrial Commission has given you written permission to be treated by a different physician.

North Carolina law requires the insurance company to pay for all reasonable and necessary medical treatment. Workers’ compensation covers medical treatment for the compensable injury or disease, as well as any physical condition arising as a direct and natural consequence of the injury. The insurance company’s physician is required to treat your injury and help manage your pain. The goal is to help you recover and return to work, if you’re able.

As you can imagine, the treating physician in a workers’ comp case can have a direct impact on the outcome of your claim and the amount of compensation and benefits you ultimately receive. The physician is responsible for setting your work restrictions and determining if and when you are healthy enough to work.

Your employer must make reasonable accommodations for any work restrictions and find you alternative work that complies with them. They also must provide vocational rehabilitation or additional training if you are unable to perform your previous job.

For serious injuries involving permanent partial disability, the doctor’s diagnosis will determine whether you qualify. Permanent partial disability is available to those workers who have reached Maximum Medical Improvement. That means, in essence, the condition will not improve with further treatment. These patients continue to have some degree of impairment to at least one of the body parts listed in the scheduled injuries. When MMI is reached, the physician will determine a percentage disability rating. This percentage is used to calculate the amount of disability benefits you will receive going forward.

There are advantages and disadvantages of being treated by the insurance company’s doctor.

Using the insurance company’s doctor may expedite the workers’ compensation process. It takes time to petition the Industrial Commission to change to another doctor. Also, the insurance company is more likely to accept the findings of its own doctor and not dispute the diagnosis.

If at any time you become dissatisfied with the insurance company’s doctor, you can ask the Industrial Commission to change physicians. It is important you receive written permission from the Industrial Commission before switching doctors. Without written permission, there is no guarantee your treatment will be covered by workers’ compensation.

There are also clear disadvantages to being treated by the insurance company’s doctor.

While many of these doctors will provide you with the same level of care as your own physician, some are less neutral than others.

Doctors hired by insurance companies may become jaded with the system and treat you as just another workers’ compensation claimant. Through the lens of workers’ compensation, they may be less likely to provide you with work restrictions, treatment, medication or even a diagnosis you may have otherwise received if you had chosen your physician. This can happen even more so if your doctor is pressured by a Nurse Case Manager hired by the insurance company to move your claim along.

There are advantages to being treated by your own family physician with whom you have a history. They have an understanding of your health and history, before and after the injury, that an insurance company doctor doesn’t.

Remember – whether you see the insurance company doctor or your own – you deserve quality and compassionate medical treatment for your workplace injuries. You must be able to trust your physicians, nurses and others in charge of your health care. If you don’t, or if you feel like you’re not receiving adequate care, it’s time to switch doctors.

We have worked with many physicians and workers’ compensation insurance companies on behalf of our clients. An experienced North Carolina workers’ compensation attorney on our team can help you get the treatment you need and the compensation you deserve.

 

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