How do you know which doctor to go to after you get hurt at work? Most people have no idea which doctor to pick. They also do not know whether they have any input in selecting a doctor to treat their injury.
This happens because most people have not had any experience with workers compensation. Here is what often happens after somebody gets injured at work
- They report the injury to their employer
- Their employer tells them, “You’ve got to go down to the urgent care clinic or the occupational doctor. This is the doctor that we use for injuries”
- Your employer send you there for treatment and you treat with that doctor because that is what they told you to do
If your employer tells you this or something similar, are they right? Also, does it really matter which doctor treats your injury?
Let me answer the second question first. It will probably matter a lot which doctor provides treatment for you.
Why is that? First of all, you want to get better. If you see a bad doctor, you will probably not get better.
Another equally important reason that your doctor matters is that doctors have a lot of power in your workers compensation case. They decide what medical treatment you need. They also have influence over whether you can return to work and what sort of work you can do. Their medical records also often determine whether you will really get the treatment you need for your injuries.
Because of all this, you want to make sure you treat with a great doctor. So, let’s talk about that first question above – is your employer right when they tell you that you have to go to their doctor?
Can the workers compensation insurance company force you to go to their doctor?
The answer to this question is “Sometimes, but not most of the time.” That answer is confusing, but you can understand it better if you understand the different roles that doctors have in a workers compensation case.
There are two basic roles for doctors in workers compensation cases:
- Doctors that provide treatment for your injury (often known as the authorized treating physician or an authorized treating physician)
- Doctor that perform an examination/evaluation but do not perform treatment (often known as IME doctors)
Different rules apply to these two different roles that doctors have in workers compensation cases. First, I am going to discuss some of the rules that apply to treating doctors and whether the insurance company can force you to go to a specific doctor for treatment.
The insurance company does not have the power to pick your workers compensation treating doctor
Great news! Neither your employer nor their insurance company can force you to go to a specific doctor for treatment of your injury. You have some choice about which doctor you see for treatment of your injury.
Your employer should have posted what is called a panel of physicians. This is a list of doctors who can provide treatment for your injury.
If you get hurt on the job, you can pick one of those doctors off the list to provide you with treatment. Th doctor you pick can treat your injury and order testing for your injury. That doctor can also refer you to other specialists who can treat your injury.
Treating with a great doctor can make all the difference in the world. You should get the treatment you need more quickly. Hopefully, the results of that treatment will be better as well if you have a great doctor.
Not only do you have the right to pick a doctor off the panel, but you also have a right to change to a different doctor on the panel if you want. This right to change doctors can be very important, especially in situations where your employer told you to pick a doctor off the list and you did not really have any helpful information to make a decision about which doctor to pick. This gives you a second chance to pick a great doctor off the list.
This article I wrote has a detailed discussion of your rights to pick a doctor off the panel of physicians. Be sure you understand those or have an attorney on your side who does because treating with a great doctor is extremely important to recovering from your injury.
When can the insurance company force me to go to a specific doctor?
Now, there are some situations where the insurance company can force you to go to the doctor they pick. The most common situation is what’s called an IME. IME is an abbreviation for Independent Medical Evaluation.
An IME is not for treatment. It is an evaluation/examination. The doctor should not perform any treatment on you at the IME. They should just examine you and prepare a report based on their examination and review of your medical records.
The insurance company uses a part of Georgia’s workers compensation law called O.C.G.A. 34-9-202 to schedule IMEs. That part of the law allows the insurance company to pick a doctor and have you evaluated by that doctor.
Often, the insurance company will tell you they are scheduling you a second opinion. They then send you an email, letter, or text with details about a medical appointment with a different doctor.
The insurance company does have the right under the law to schedule those examinations and to force you to attend them. However, they have to follow certain very specific rules to schedule the examination. This article I wrote provides a more detailed discussion of IME evaluations and the rules that apply.
One common mistake many people make is continuing to treat with the IME doctor after the appointment. The insurance company has a right to schedule the IME with the doctor they pick, but they do not have a right to just change you to that IME doctor for ongoing treatment.
Any ongoing treatment would have to be with your agreement to change doctors or a workers compensation judge ordering a change of doctors. But, if you just start going to the doctor the insurance company wants you to see, they will probably let you continue doing that because they have now gotten you to the doctor they want you to see. You have to fight to make sure you continue seeing the great doctor you want to see and not the doctor the insurance company wants you to see.
Why does the insurance company schedule an IME?
The insurance company usually uses the medical reports from IME evaluations to try to avoid paying benefits to you. They hope that the IME doctor will say that you do not need medical treatment or that you can go back to work.
Some of the most common situations where insurance companies schedule IMEs are:
- When they are unhappy about expensive treatment or surgery recommended by your authorized treating physician
- When they hope to get an opinion that you can go back to work so that they can stop paying you wage loss benefits
Insurance companies are businesses. IMEs can be very expensive. If they are going to spend money sending you to a doctor, they are hoping to get an opinion that will help them save money on your case.
Because of this, you should be cautious whenever the insurance company has scheduled you for an IME. Many times, the report of the IME doctor will hurt your workers compensation case.
Can the insurance company ever force me to treat with a specific doctor?
Not usually. The one situation where the insurance company can force you to treat with a specific doctor is when they succeed in getting your doctor changed. This generally happens after a hearing or as a result of a request to change physicians.
A judge at the State Board of Workers Compensation can say that a particular doctor is the authorized treating physician in your workers compensation case. In certain situations, you can lose your right to workers compensation benefits if you do not treat with your authorized treating physician. So, the insurance company can potentially force you to treat with this doctor or have you risk having your workers compensation benefits suspended.
Do I have rights to see the doctor I want?
Yes, to an extent. Your rights to treat with the doctor you want are dependent on whether your employer followed the rules. If your employer properly posted and explained the panel of physicians, your rights will be fairly limited. If your employer did not follow these rules, you will often be able to choose any doctor you want for treatment.
You also have rights to get a second opinion or an IME paid by the insurance company in certain situations. There are limits on these rights, but they can be helpful in getting you evaluated by a great doctor. Also, the reports from these second opinion or IME evaluations can often be used to get your doctor changed so that you can get the treatment you need.
