Workers’ comp has strict rules regarding how workers must get treatment for their work-related injuries. Seeking treatment at the right time, and from the right doctors, can go a long way to maximizing your workers’ comp recovery. Here are some tips on when to get treatment, which doctors to see, and how to get your medical bills paid.
Seek Treatment Immediately
If you're injured on the job, you should notify your employer right away and seek treatment as soon as possible. If your injury requires emergency care, you can go to any hospital or emergency room. If you don't need emergency care, you will need to choose a doctor based on the workers’ comp rules in your state (discussed below).
Either way, it’s important not to delay getting medical attention for your injury. A delay in seeking medical treatment is a common reason for a workers' comp claim denial. Insurance companies are often suspicious of these types of claims; they assume that if you were actually hurt, you would have seen a doctor right away. Even if your work-related injury is relatively minor, don’t wait to see if it will get better on its own or try to tough it out without treatment. (For more information on how medical treatment can impact your workers' comp case, see Workers' Comp Medical Issues FAQ.)
Go to the Right Doctors
Each state has different rules about which doctors are allowed to treat work-related injuries. In some states, such as Ohio, the employee may choose any doctor that is certified by the workers’ compensation board. In other states, such as New Jersey, the employer or its insurance company gets to choose the doctor. The rules are even more complicated in other states. For example, in California, a worker can predesignate a primary care physician to treat work-related injuries at the time the worker is hired, if the employer offers group health care coverage. If the employee doesn’t predesignate a doctor, the employee must typically see a doctor from the employer’s medical provider network.
It’s important to follow the rules in your state regarding which doctors you can treat with. If you fail to follow these rules, the medical treatment may not be covered. If you’re unsure about the rules in your state, consult your state’s workers’ compensation agency or a workers’ comp attorney. (To find a qualified lawyer in your area, see the Lawyers.com attorney directory.)
When you have the opportunity to choose your own doctor, it’s in your best interests to do so. Doctors selected by employers or their insurance companies have a tendency to downplay the worker’s injuries and minimize treatment, in order to save the employer money. By choosing a doctor you trust, you can make sure that you get the treatment and time off from work that you need to get better.
Not all doctors are willing to treat work-related injuries, however. Workers’ comp has specific rules that doctors must follow in order to get reimbursed, which some doctors don’t want to bother with. When you call for an initial appointment, tell the office that you are coming in for a work-related injury. If the doctor won’t treat you, you may be able to get a referral to another doctor who does treat work-related injuries. In most cases, once you’ve found a treating doctor, the doctor’s office will bill your employer or its insurance company directly.
Change Doctors if Necessary
Most states will allow you to change doctors if you’re not happy with the treatment you are receiving. However, each state has its own rules on when you can switch doctors, how many times, and what you must do in order to make the change. For example, in Florida and Georgia, you can request a new doctor only one time during your workers’ comp claim. In states where the employer has an established medical provider network, you may be able to switch multiple times, but only to doctors within the network. In some states, such as Texas, you will need to get approval from the workers’ compensation board before changing doctors.
If you want to change doctors, be sure to follow the rules in your state. This might mean seeking board approval, choosing a doctor from a certain list, or filing necessary paperwork.
Get Your Medical Bills Paid
You must notify your employer of your injury in order to have your medical bills paid by your employer. In some states, you may also be required to file an official workers’ comp claim before you can receive any benefits. That’s why it’s important to notify your employer of a work-related injury and file a claim as soon as possible. In some states, employers are required to pay for your medical treatment during the time that you're waiting for your claim to be approved or denied. If your claim is approved, your employer will continue to pay your bills. If it is denied, the employer will stop paying until the denial is overturned. (For information on overturning a denial, see How to Appeal a Workers’ Compensation Denial.)