Choosing a Doctor for a Workers’ Comp Claim: Options & Legal Rights
May 3, 2023 Workers' Comp
Your treating doctor plays a crucial role in your Workers’ Compensation case. They determine when you can return to work and what benefits you will receive — and ultimately, help you heal from an injury. Choosing a physician for a work injury is an extremely important decision. You may be wondering, “Who gets to choose my Workers’ Comp doctor?”
It may come as a surprise that the decision can be up to your employer, depending on Workers’ Compensation laws in your state. There are certain legal remedies available to fight this decision if you do not agree with the doctor your employer selects, or if you wish to seek a second opinion. Below is an overview of the legal rights of an employee who is injured at work in Missouri and Illinois. Contact a Workers’ Comp attorney for more information.
Step One: Reporting a Work Injury
Remember to report any work injuries to your employer before you seek medical care. For a serious illness or injury requiring emergency medical attention, reporting the injury first may not be possible. Otherwise, your employer and/or their insurer is required to provide medical treatment. In order to be eligible for Workers’ Compensation benefits, you must report an injury within 30 days of the date of injury in Missouri, or within 45 days in Illinois.
Keep track of important documentation, such as medical bills or communications with your employer and insurer, throughout your recovery. Read more about how to report a workplace injury.
Who Determines My Workers’ Compensation Doctor?
We will use this hypothetical work injury to explain how a doctor could be selected by an employer in Missouri or Illinois:
John had a pallet dropped on him at work and broke his foot. First, he went to the emergency room and got an X-ray of the injury. The next day, he reported the injury to the Human Resources department at work to initiate the Workers’ Compensation process.
In Missouri, John’s employer has the right to choose the health care provider(s) for his treatment plan, which could include ongoing physical therapy to restore full mobility to his injured foot. It is common for employers to allow the insurance company to choose the care provider, but if the employer and the insurance company disagree on providers, the employer will ultimately have the final say in the decision.
In Illinois, John has the ability to choose his doctor(s) as long as the treatment is reasonable, necessary and related to his injury. The so-called “two doctor rule” allows an injured worker to select two doctors and then receive medical care from their chosen doctor, as well as any other health care providers referred by the chosen doctor.
It is important to note that the following treatments do NOT count towards one of the two doctor choices in Illinois:
- First aid
- Emergency care
- Mandated medical examinations by employer-chosen physicians
- Referrals to other providers and specialists made by the chosen doctor
Disputing the Worker’s Comp Doctor Selected by Your Employer
Some workers worry that a doctor selected by their employer will have a conflict of interest and might minimize their injuries — and unfortunately, this can happen. While you have the right to see your own doctor, you may be responsible for the cost of treatment if you choose this option.
In Missouri, you have the right to seek medical care from the doctor of your choice at your own expense. Your employer MAY authorize you to see your own doctor, but you should always check with your employer and their insurance company before pursuing treatment. The insurance provider will often recommend another doctor to your employer. If you don’t like the doctor and you have a good relationship with your employer, you can ask them to request a change through the insurance company.
Using the example scenario in the section above, if John decided to pursue treatment with his own doctor without authorization from his employer, he would almost certainly be responsible for 100% of the cost of his treatment. If John’s employer did authorize an alternate physician, the reverse would generally be true.
In Illinois, the two doctor rule gives an employee much more control in choosing the treating physician for a Workers’ Comp injury. If the first doctor chosen does not seem to be a good fit, the employee is able to consult a second physician.
If you believe you are not receiving adequate care, you may be able to change doctors as long as you follow your state’s rules for doing so. Although Missouri law does not require your employer or their insurance company to authorize a second doctor, this should not stop you from asking. If your request is denied, or if you are unsure how to advocate for yourself while seeking treatment for a work injury, contact an experienced Workers’ Comp attorney in St. Louis.
Our Workers’ Compensation Attorneys Will Fight for You
A work injury can leave you in pain and sidelined for weeks without your normal paycheck — but the consequences of receiving inadequate medical care for your injury can be much more severe and even life-altering. Navigating the complex Workers’ Compensation process and insurance denials is a lot to take on when you are already trying to focus on your recovery.
When you need someone to advocate for your best interests, contact the experienced Workers’ Comp attorneys at Padberg Appelbaum Knepper in St. Louis.
Through decades of experience successfully resolving Workers’ Compensation disputes, we understand how important it is for injured workers to receive treatment from a doctor they trust. Our team of Workers’ Compensation lawyers will go head-to-head with your employer and their insurance companies to fight for you.
If you were injured at work, reach out today to schedule a free, confidential consultation to discuss your concerns. Submit a contact form online, or call (314) 621-2900.