15 May, 2024

Can I Go to My Own Doctor for Workers’ Comp?

Author Todd A. Strong
Female patient speaking with her paediatrician in a doctors office. can i go to my own doctor for workers comp
Female patient speaking with her paediatrician in a doctors office. can i go to my own doctor for workers comp

After workplace injuries, victims often ask, “Can I go to my own doctor for workers’ compensation?” Illinois law allows workplace accident victims to choose their own doctor, but there are some things you need to know.

Call Strong Law Offices at 309-688-5297 for legal advice regarding your workers’ compensation claim. You are not bound to using the doctor recommended by your employer, although there are rules to consider before switching to your own doctor.

The Role of Designated Workers' Compensation Doctors

Designated workers’ compensation doctors serve a crucial function within the framework of the workers’ compensation system, acting as the primary medical evaluators for injured workers. Their role encompasses key responsibilities that directly impact the outcome of workers’ compensation claims.

Designated workers’ comp doctors are tasked with assessing the nature and extent of work-related injuries. They conduct thorough examinations, review medical histories, and order diagnostic tests to form accurate diagnoses. These evaluations serve as the foundation for determining the appropriate course of treatment and the level of compensation the injured worker may be entitled to.

Additionally, designated doctors play a pivotal role in providing medical documentation and reports that serve as evidence in the claims process. Their detailed assessments outline the causation of the injury, its impact on the worker's ability to perform job duties, and the expected prognosis. Insurance companies and employers rely heavily on these reports to adjudicate claims and make decisions regarding benefits.

Furthermore, workers’ comp doctors are responsible for developing treatment plans aimed at facilitating the injured worker's recovery and rehabilitation. They prescribe medications, therapies, and interventions tailored to address the specific needs of each individual. By closely monitoring the progress of treatment and adjusting interventions as needed, these doctors play a vital role in optimizing outcomes for injured workers.

Doctors often collaborate with other healthcare providers, such as physical therapists and occupational therapists, to ensure comprehensive care for injured workers. This multidisciplinary approach helps address not only the physical aspects of the injury, but also any psychological or emotional challenges the worker may face during the recovery process.

In essence, designated workers’ compensation doctors serve as frontline healthcare providers within the workers’ compensation system, delivering medical care, providing documentation, and guiding injured workers through the process of recovery and rehabilitation.

Is There a Requirement for Injured Workers to See a Doctor Approved by Their Employer?

When you suffer an injury, you have the right to seek emergency care from any medical professional. If you need to be rushed to the emergency room, you don’t need your employer’s approval as to which emergency room you can visit. In fact, before you have notified your employer of the injury, you can seek treatment from any doctor.

You typically have 45 days to notify your employer of the injury, although workers’ compensation attorneys generally recommend that injured workers notify their employers as soon as possible. If your employer has a preferred provider program (PPP), he or she must notify you of this program and provide you with a list of approved doctors. You can then choose two physicians from this list.

Can You Choose Your Own Doctor?

You can opt out of the PPP program and instead seek care from your own physician. Injured employees who choose to opt out of an employer’s PPP programs can choose one physician instead of the two from the PPP list.

In short, you have two options. You can either select two doctors from your employer’s Preferred Providers Program, or you can pick one physician of your own, who can be your regular primary care physician.

Your employer cannot deny you workers’ compensation benefits for choosing your own physician. In Illinois, employers cannot force injured employees to see their approved physicians.

However, it is important to get a referral from your primary physician before visiting a specialist. This applies whether the physician you are seeking primary treatment from is on the approved PPP list or you have selected him or her yourself. Otherwise, your employer can make a claim that seeing the specialist was not medically required and should thus not be included in workers’ compensation.

Can You Change Doctors During a Workers’ Comp Claim?

You can opt out of your employer’s Preferred Providers Program either before or after starting treatment. Even if you started treatment with an approved physician, you can opt out and change your doctor at any time.

Perhaps you feel that the quality of care from your employer’s approved doctor is insufficient or unsatisfactory. Or, you simply prefer the care you get from your regular primary care provider.

Nevertheless, it is important that you feel safe and comfortable with the doctor you are seeing, without needing to worry about bias. Therefore, it is acceptable to request a change to another doctor who is not approved by your employer.

Your employer may object to your change. If that happens, the Illinois Workers’ Compensation Commission, which is tasked with managing workers’ compensation issues, will determine whether a change of doctors is justified.

How Does a Workers’ Comp Doctor Influence Your Claim?

A workers’ comp doctor plays a pivotal role in the trajectory of a worker's compensation claim, wielding considerable influence over the outcome. His or her evaluations and reports can impact the compensation an injured worker receives and the duration of allotted benefits. Understanding the dynamics of this relationship is crucial for anyone navigating the complex landscape of workers’ compensation.

The selection of the workers’ comp doctor is often not within the injured worker's control. In many cases, employers or insurance companies designate a list of approved physicians from which the injured worker must choose. This lack of choice can lead to concerns about impartiality, as the doctor may have a pre-existing relationship with the employer or insurer.

Once the injured worker sees the designated doctor, his or her assessment holds substantial weight in determining the severity of the injury and its impact on the individual's ability to work. The doctor's diagnosis, treatment plan, and prognosis directly influence the benefits the injured worker may receive. For instance, if the doctor deems the injury minor and expects a quick recovery, the worker may receive limited compensation or be pushed to return to work sooner than he or she feels ready.

The workers’ comp doctor's medical reports serve as critical evidence in the claims process. These reports detail the nature of the injury, its causation, and the recommended course of treatment. Insurance companies and employers heavily rely on these reports to assess the validity of the claim and determine the level of compensation owed. Therefore, the doctor's documentation can either bolster or undermine the injured worker's case.

The workers’ comp doctor's influence extends beyond medical matters to include vocational assessments and disability ratings. These assessments evaluate the worker's ability to perform job duties and determine the extent of any permanent impairment. A favorable assessment can result in higher disability benefits, whereas an unfavorable one may lead to reduced compensation or even denial of benefits altogether.

Unfortunately, some workers’ comp doctors may prioritize the interests of the employer or insurer over those of the injured worker. They may downplay the severity of the injury, rush to declare the worker fit for duty prematurely, or recommend treatments aimed at minimizing costs rather than prioritizing the worker's recovery. This conflict of interest can result in unjust outcomes for injured workers, leaving them without the compensation and support they need.

In light of these dynamics, injured workers should approach their interactions with workers’ comp doctors with caution and awareness. It's essential to communicate openly and accurately about the extent of the injury and its impact on daily functioning. Seeking a second opinion from an independent physician can provide valuable perspective and ensure that the worker's interests are adequately represented.

Additionally, injured workers should familiarize themselves with their rights under workers’ compensation laws and regulations. They have the right to request a change of doctor if they believe the current doctor is biased or providing inadequate care. Moreover, they can seek legal representation to navigate the complexities of the claims process and advocate for fair treatment.

If you’ve sustained injuries in the workplace, and you have concerns regarding your claim, contact the workers’ comp lawyers at Strong Law Office. 309-688-5297.

About The Author

author-bio-image
Personal Injury Lawyer Todd A. Strong Illinois workers’ compensation and personal injury lawyer Todd A. Strong is the founder of Strong Law Offices in Peoria, Illinois. Todd brings considerable legal knowledge, experience, and skill to the table to ensure injured victims throughout the state are treated with respect, dignity, and fairness.
Years of Experience: More than 20 years
Illinois Registration Status: Active
Bar & Court Admissions: Illinois State, 1994
U.S. District Court, Central District of Illinois, 1994
U.S. District Court, Northern District of Illinois, 2022
U.S. District Court, Southern District of Illinois, 2023
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About The Author

author-bio-image
Personal Injury Lawyer Todd A. Strong Illinois workers’ compensation and personal injury lawyer Todd A. Strong is the founder of Strong Law Offices in Peoria, Illinois. Todd brings considerable legal knowledge, experience, and skill to the table to ensure injured victims throughout the state are treated with respect, dignity, and fairness.
Years of Experience: More than 20 years
Illinois Registration Status: Active
Bar & Court Admissions: Illinois State, 1994
U.S. District Court, Central District of Illinois, 1994
U.S. District Court, Northern District of Illinois, 2022
U.S. District Court, Southern District of Illinois, 2023