Why Do I Need a Workers’ Comp Doctor?

Your doctor will play an important role in your workers’ compensation claim. When filing the initial claim, your doctor’s report will be the legal basis for justifying your eligibility for workers’ compensation benefits. If you do not have a medical examination to establish the nature and extent of your injury, your claim will be denied.

Be sure that your doctor prepares an official report using the forms required by your state’s workers’ compensation review board. Your employer’s insurance carrier will require the specific form for your state to accompany your workers’ compensation claim. If the doctor does not report that you are unable to work, the insurer isn’t required to start your disability payments. Most doctors have the correct form. However, you may ask the insurer for the required forms for your own doctor to complete. Most workers’ compensation boards have websites where you can download the forms.

Your Workers’ Comp Doctor Report

If your doctor and the workers’ comp doctor for your insurer disagree on the nature and extent of your injury, the workers’ compensation review board may choose a third physician to conduct another examination. It is important that your doctor provides a fair and honest evaluation of your condition. If your claim is disputed and requires a hearing, the strength of your doctor’s report will be tested in court. Therefore, it is important that you do not attempt to influence your doctor’s decision. All workers’ compensation review boards take fraud very seriously. If they have a sense that your medical condition is being exaggerated, they will deny your claim.

Your doctor’s objective and unbiased examination of your condition are essential to the success of your claim.

Am I Required to See a Workers’ Comp Doctor?

To be awarded a workers’ compensation benefit, your claim must have medical evidence of your injury. Therefore, you must see a physician, which can be a workers’ comp doctor employed by your company’s insurer. The doctor’s medical report will provide the legal basis for your injury claim.

Depending on your state, you may be able to choose the doctor that treats your injury. The types of medical professionals from which you may receive treatments include medical doctors, surgeons, dentists, optometrists, osteopaths, and chiropractors. You have the right to change your doctor only once. You must alert the insurance company when you do so. Subsequent changes of your treating doctor require written approval from the insurance company. If your treating doctor refers you to a specialist, this is not considered a change of doctors.

Regardless of whether you carry health insurance, alert your doctor that you are being treated for a workplace injury. Supply your medical providers with the name and contact information for your employer and their insurance carrier. The medical expenses that you incur as a result of your injury; including doctors’ fees, prescriptions, medical supplies, physical therapy and other treatments, will be paid by the insurance company. In addition, the insurer will cover any related travel expenses including gas, food, and lodging.

Do I Have to See the Workers’ Comp Doctor My Employer Chooses?

You have the right to choose the doctor that treats your work-related injury. If your employer requests that you see a workers’ comp doctor of their choosing, this request should be made by their insurer. If you receive such a request, you are required to participate in this examination. The insurer may request that their workers’ comp doctor examine you as often as every 60 days.

Similar to the regulations governing the patient’s choice of doctor, the insurer may only change its examining doctor once. If the insurer’s doctor refers you to a specialist this is not considered a change of physician. The insurer will pay the costs of the examination. If you do not participate in the examination your benefits may be terminated until you visit their doctor.

If you have concerns regarding your employer’s request for a medical examination, consult a workers’ comp attorney about your case for free.

Who Determines Whether I Can Work Again?

The decision of when you are able to return to work is a medical one. The insurance company cannot tell you to return to work, nor can your employer. If you had consistent reports from your workers’ comp doctor during treatment, your medical report will reflect appropriate actions to take regarding returning to work. Your primary physician should be the one that makes the medical determination of when you have achieved a complete medical recovery and are able to return to work in a part-time or full-time capacity.

What Happens When My Company’s Workers’ Comp Doctor Disputes My Treating Physician’s Assessment?

If the insurer’s workers’ comp doctor disputes your treating doctor’s medical opinion, there is a process of litigation to protect you from bad faith determinations on the part of the insurance company. Should your case reach this point, it is highly recommended that you secure professional legal representation.

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