If you have an on-the-job injury, you need to obtain medical treatment for that injury on a consistent and regular basis. You must choose an attending physician to manage your medical care. Unless your insurer enrolls you in a Managed Care Organization (see below for more information), you have the right to see any physician willing to treat your workers compensation claim. Not every physician will agree to act as your workers compensation doctor.
Although you can initially treat with a nurse practitioner, chiropractor, or physician assistant, these types of medical providers can only provide off-work verification for up to 30 or 60 days, depending on the type of provider. If you are receiving temporary disability benefits because you cannot perform your regular work, you need to be seen every 30 days by an actual doctor (someone with an MD or DO after his or her name). If you are receiving temporary disability benefits and are not treating with an actual doctor, the insurance company can stop paying you benefits until you begin treating with an actual doctor.
If you do not like your attending physician, you may switch to a different physician. If you decide to change physicians, your new physician must fill out an 827 form. You can only change your attending physician twice for the duration of your claim.
If your attending physician takes you off of work or gives you work restrictions, you need to make sure you get a copy of your restrictions before you leave the doctor’s office. Your employer or workers compensation insurer needs your current restrictions so you can timely receive the temporary disability benefits that you are owed.
You must be completely honest with your attending physician. The amount and type of your workers compensation benefits depend almost entirely upon the opinion of your attending physician. In order to be valid, your attending physician’s opinion must be based on accurate and truthful information.
Your attending physician may refer you to a specialist such as a neurosurgeon or an orthopedist. If you then begin treating with a specialist, that specialist may become your attending physician for a period of time. As long as your doctor referred you to the specialist, the change from your original doctor to the specialist does not count as one of your three allowable changes in attending physician. You will still retain the right to change attending physicians twice more.
Managed Care Organizations (MCO)
Your workers compensation insurer may enroll you in a Managed Care Organization (MCO). An MCO works as a “middle man” between the insurer and your physician. The MCO will have a panel of medical providers; if enrolled in an MCO, you must choose an attending physician from this panel. If you treat with a “non-panel” doctor, the insurer will not pay those medical bills and you will not receive temporary disability benefits even if your doctor takes you off of work.
Insurer Mandated Medical Evaluations (IME)
Insurers have a right to have you see a doctor or panel of doctors of their choice. Insurers refer to these as “Independent Medical Evaluations (IME).” They are not independent, and you need to be aware that the doctors are not on your side, and in a significant way are not really independent of the insurance companies. Insurers use these doctors to evaluate your claim to determine whether the injury was the major cause of your need for treatment, or whether a preexisting condition was. They also use them to try to help them persuade your attending physician that your disability is not related to your industrial injury, but is rather related to a preexisting condition. The law requires that you attend the so-called IME appointment. You are always entitled to mileage to and from the IME..
If you have questions about your attending physician, an upcoming IME appointment, or want to know if you are enrolled in an MCO, Contact Moore and Jensen for a free consultation. We have over 60 years combined workers compensation experience and our attorneys and professional staff will answer any questions you might have.