If you are filing a work injury claim, you must use your employer’s workers’ compensation doctor for the first 90 days. There are several rules regarding choice of medical providers that you should know when you are filing a claim for benefits. We will briefly discuss some of your rights and rules below.
For specific answers about your case or for help applying for or appealing a claim, contact one of our work injury attorneys at Cordisco & Saile LLC: 215-791-8911.
Medical Providers and Pennsylvania Workers’ Compensation Claims
Many employers post a panel of physicians in a prominent location on the worksite, such as in a break room or on a locker room bulletin board. They also usually post the list next to any other legally required workers’ compensation information.
This list contains contact information for company-approved physicians that workers can see. If your employer has posted a physician’s panel, you must use a doctor on the list.
Note: You can choose any doctor on the list; your employer cannot sway you to choose any single provider.
You must use a company doctor for your work injury, but only for the first 90 days. After that time, you can elect to go to any doctor of your choosing. Also, if your employer does not provide you with a panel of physicians, you can use any doctor you want, even during the first 90 days.
There is another exception to the company doctor requirement. If your business’ doctor recommends invasive surgery, you may obtain a second opinion from your doctor of choice. Workers’ compensation insurance will cover this visit. However, a company doctor must be the one to carry out whatever treatment the second doctor recommends if it is during the first 90 days.
The 90-Day Rule for Workers’ Compensation Treatment
There are a few more details about this 90-day rule that you should know:
- If during this 90-day period you visit a provider not on your employer’s list, such as your doctor or a specialist that your doctor recommends, your employer or its insurance carrier has the right to question your claim and could refuse to pay immediately.
- While you may choose the doctor from whom you wish to receive treatment after the 90 days (or for the reasons stated above), you must immediately notify your employer of your selected provider. While you are continuing treatment, you should give your employer and his workers’ compensation insurer monthly reports from the doctor who is treating you.
- If you end up choosing your provider for any reason during treatment, be prepared for some resistance by your employer and the insurance carrier. Many disputes arise from requests for information that you and your doctor should provide them with, such as certain forms, medical records, and written correspondence between you and your treating physician.
- In many – but not all – cases, choosing your doctor after a work injury is your right. However, the insurance company, because it wishes to control treatment (and compensation), will often overly scrutinize the process. If all goes well with treatment by a doctor on your employer’s list, then the compensation process will likely pose no problems.
Independent Medical Examinations
It is also important to be aware that any time while you are receiving workers’ compensation benefits, your employer has the legal right to request that you submit to an independent medical examination (IME).
A separate physician that is neither your regular workers’ compensation physician nor your regular doctor will conduct the IME. The IME provider will be a physician of your employer’s choosing, and you must attend the exam. Failure to do so will likely result in a cessation of benefits.
IMEs can be helpful in some cases. Bona fide exams give a fair and accurate assessment of the worker’s condition. But, there is a downside. The pitfall of IMEs is that while they are supposed to be “independent,” they are often biased. In many cases, IME examiners are partial to employers. After all, their task is to ultimately serve as the company’s medical expert (in opposition to you), and they are usually handpicked by and paid by the employer.
Examiners can be very quick to release workers to light duty for the employer’s benefit. So, in the context of a workers’ compensation dispute, there will always be some form of unavoidable bias when the physician administering the IME has to provide a professional opinion about the employee’s condition.
If your employer has requested that you submit to an IME, call your attorney. It is likely an indication that your employer/insurer is attempting to shut off your benefits. While workers’ compensation laws do not allow your lawyer to attend the IME with you, he can explain how to handle the exam and how to prepare. He can also explain the benefits and rules regarding having your own health care provider present with you at the examination.
What do I do if I am unsatisfied with my care?
When you sustain an injury on the job, you have rights to quality, company-sponsored (free) medical care. If you believe your treating physician or employer is pushing you to return to work before you are physically capable; if you disagree with treatment recommendations or your disability rating; or if you do not believe you are receiving quality care, you will want to speak to a workers’ compensation attorney straightaway.
Your workers’ compensation attorney can explain exactly what your rights and options are, and how best to move forward. If your employer has denied or prematurely shut off your benefits, your lawyer can help you appeal the decision with the Bureau of Workers’ Compensation.
Free Legal Consult with a Workers’ Compensation Lawyer
If you are having troubles getting the treatment or benefits you deserve after a accident on the job, please call Cordisco & Saile LLC for help. We routinely help workers with all types of injuries secure their much-needed income and medical benefits.
Contact our Bristol, Pennsylvania office today at 215-791-8911 for a free, no-obligation consult today.