Important: We updated this article in November 2024 after reviewing policies and laws for all 50 U.S. states. If you’ve been injured at work, a workers’ compensation doctor is likely the first person you must see. Why? Because medical bills form the basis of every successful workers’ compensation claim for benefits. Without medical care, it’s impossible to get any benefits from your employer’s workers’ compensation insurance provider.
But this type of appointment is quite different from a yearly physical or other routine visit with your family doctor. Keep reading to learn what workers’ comp doctors do, how to prepare for your visit, and more helpful tips.
Workers’ Compensation Doctor Visits: Key Takeaways
- Workers’ compensation doctors are health care providers just like your family physician, but with additional certifications. They often appear in your employer’s insurance company’s list of approved treating physicians or authorized providers.
- Your employer’s insurance company or a state workers’ compensation fund usually pays for appropriate medical treatment. In most states, workers’ compensation insurance makes those payments directly to the doctors themselves. But if you seek treatment before notifying your employer, you may receive reimbursement for that first visit.
- Your workers’ comp doctor looks for signs that indicate you aren’t entirely truthful about your occupational injury.
- Each state’s individual workers’ compensation rules and regulations determine how you receive medical care and who chooses your doctor.
- A 2018 study found injured workers with attorneys received settlement payouts 5 times larger than those without legal representation.
Understanding the Role of Workers’ Compensation Doctors
A workers’ compensation doctor is one of the most important people you’ll interact with when you apply for those benefits. This is because doctors determine not just your diagnosis and treatment, but when and if you can return to work.
Here are just a few things that a workers’ comp doctor does for injured employees:
- Performing an Independent Medical Exam (IME) to evaluate your condition or injury.
- Identifying and referring specialists for care that goes beyond what they can provide for you.
- Determining whether you can work again full-time, light duty only, and if you have a permanent impairment or disfiguring injury.
A workers’ compensation doctor, in some cases, can be your own family physician. However, many states require you to seek ongoing care from previously approved physicians. It’s important to remember that distinction, and that your interests and that of the insurance company may be at odds.
It’s also important to know workers’ compensation doctors often complete special training to perform this role. This is sometimes required under state law to treat work-related injuries and diseases. This training teaches them things your family doctor may not know, such as:
- How the state structures workmans’ compensation fees for different medical procedures, prescription drugs, or treatments
- Current trends in workers’ comp that may apply to your situation
- Which forms to complete and submit to different agencies, and their filing deadlines
How Much Does a Workers’ Comp Doctor Cost?
Your employer’s insurance provider or your state’s worker’s compensation fund should pay all eligible medical benefits for work-related injuries.
What happens, though, if you need urgent care relating to a workplace injury? There may not be time to research or find the appropriate doctor. In that case, always seek care first and keep copies of your bills for reimbursement purposes later.
Do I Have to See a Company Doctor Approved by My Employer?
This depends entirely on the workers’ compensation laws in the state where you work. Because state laws can change, it’s important that you check with your state’s workers’ compensation board. See online contact information for each state’s office.
Some places, you may need to see a workers’ comp doctor chosen by your employer’s insurance company or your state’s governing body. In some states, injured workers may choose their own doctor, but only if certain requirements are met. Again, because the rules vary state to state, it’s smart to contact your state’s workers’ compensation office for current regulations.
What if I’m not Happy with my Current Workers’ Comp Treating Physician?
Sometimes, the doctor you must see under your state’s laws is less than ideal for the medical care you need. This can happen for a variety of reasons:
- Their office is too far from your home or work site to receive the care you need in a timely manner.
- Maybe their bedside manner is lacking, or you have a personal conflict of interest from past interactions.
- You need to see a specialist (for carpal tunnel surgery, for example), but no authorized providers exist in your area.
If this is the case, most states will allow you to change doctors. But you may need written authorization from your employer’s insurance company before you can make that switch. Be sure to check with your supervisor or HR department at your job before you change providers.
The Role of Medical Treatment in Workers’ Compensation Claims
The first thing to remember is that you cannot receive workers’ compensation unless you see a doctor first for medical care. So, the question isn’t whether you should seek medical treatment; it’s when.
The next important thing to remember is that the attending physician you see isn’t focused on you. Instead, that doctor’s goal is to report to the insurance company any information that can help them deny you benefits.
Specifically, the doctor you see during your medical visit will be looking for things like:
- How you react when you receive treatment
- Whether you mention any previous injuries or pre-existing conditions during your medical examination
- How much pain you are in
- If you currently participate in activities that prove that you are not disabled or injured and can return to work again
Urgent Care for Life-Threatening Injuries
Most states will allow you to visit an ER or hospital for urgent care without prior employer approval first. However, there are rare exceptions (like Connecticut).
Your health should always be your number-one priority, and medical treatment is the only path to receiving workers’ compensation benefits. If you must seek urgent medical care before informing your employer, be sure to:
- Inform the doctor or facility that you’re there to treat a work-related injury or illness.
- Ask if the provider has any forms you need to fill out or sign for workers’ comp purposes.
- Keep copies of any receipts or bills from your visit to pass along to your employer’s insurance provider.
- Tell your supervisor or HR department at work about your injury accident as soon as you reasonably can. It’s always best to complete this step in writing and keep a separate copy for your own records.
Independent Medical Exams
An Independent Medical Exam (IME)is basically a second opinion to confirm your diagnosis and inability to work. Insurance companies may require you to attend one after filing a workers’ comp claim, but not always. If your employer’s insurance company orders an Independent Medical Exam, then you absolutely must go. Not going may end your benefits or allow the insurer to reduce your payments under your state’s workers’ compensation laws.
Doctor’s Visits for Ongoing Care During Normal Work Hours
If you require regular care for an injury that happened at work, your employer must let you leave for treatment. But in general, they don’t have to pay you for the time you take away from work for those appointments. Rather, you will be bound by your employer’s policies and the laws of the state where your employer operates. So, if your employer’s policy states that you can use accrued sick time for those doctor’s appointments, do that. Or perhaps it’s PTO time you must use to attend your physical therapy visits, for example.
If your employer doesn’t offer paid time off, then you might have to make up the hours needed to accommodate your medical appointments. And that could be true even if the injury or illness is work-related and eligible for workers’ compensation coverage.
Since this varies from state to state, check your state’s workers’ compensation office for any regulations that affect your situation.
How Reaching MMI Affects Your Claim
MMI, or Maximum Medical Improvement, means your injury is not likely to improve with additional treatment. This could mean one of three possible things for your workers’ compensation case:
- Full recovery from your injury so you’re now able to return to work again at your prior earning capacity.
- Your ability to earn a living is permanently limited by a disfiguring injury or impairment of some kind.
- You can no longer work enough to support yourself financially and should now qualify for disability benefits.
When you reach Maximum Medical Improvement, in many states, your workers’ compensation ends and you may receive a lump-sum settlement. In other states, you may qualify for monthly permanent total disability payments until you turn 67 years old. However, not every state has a workers’ compensation law that allows for those types of payments.
If you still need ongoing income but cannot work, it’s time for you to apply for Social Security disability. Your doctor plays an important role in this process. They can help you contest MMI, if they think that’s appropriate. They can also provide documentation that proves you’re too disabled to work, so you can start on that claim paperwork.
Tips to Make Your Workers’ Comp Doctor Visits Go Smoothly
Like any other important appointment, you should try your best to be prepared for your medical appointments. Here are a few things you can do:
1. Review all relevant workers’ comp paperwork before your appointment. The workers’ compensation insurance company will have paperwork that includes information about your injury accident and other details. It’s important to review that information thoroughly so you can correct any mistakes early on in your treatment plan.
2. Read over your medical history and records. Reviewing your medical records can help refresh your memory about past injuries and illnesses, medication prescriptions, and prior treatment history. Your treating doctor will probably ask about your medical history and any pre-existing conditions. Reviewing your records before your appointment can help you answer questions honestly and quickly.
3. Refresh your memory about the accident that injured you. You’ll almost certainly have to describe the accident circumstances that led to your injury and reason for seeking medical care. Details you need to relay include exactly how your work injury happened, how it affects you now, and any witnesses. The medical provider needs to understand whether you truly have a work-related injury and therefore are eligible for workers’ compensation benefits.
Get Free Expert Help Resolving Workers’ Compensation Claim Disputes
The number-one reason most people don’t get workers’ compensation benefits is because they’re scared to report their injuries. Maybe you think your employer will fire you if you report an injury at work (which is illegal in all 50 states). Or maybe you aren’t sure if your employer has insurance coverage, or how to apply for those benefits.
A workers’ comp attorney is also your best possible ally when it comes to disputed claims. Why do we say this? In some states, as much as 50% of injured workers filing applications for workers’ compensation get denied benefits. But workers’ comp attorneys always offer free consultations for people interested in learning whether they have a valid claim.
All workers’ comp lawyers also work on contingency. That means they won’t accept you as a client unless they’re reasonably sure your injury qualifies for benefits. And if you don’t win a settlement, then you pay $0 for legal assistance.
Want to talk to an attorney near you for free about your own case? Click the button below now to start your free online benefits quiz and see if you may qualify:
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Lisa Allen is a writer and editor who lives in suburban Kansas City. She holds MFAs in Creative Nonfiction and Poetry, both from the Solstice Low-Residency Program in Creative Writing at Pine Manor College. Prior to becoming a writer, Lisa worked as a paralegal, where she specialized in real estate in and around Chicago.
