10 Jan, 2023

How Do Workers’ Comp Doctors Get Paid in Bloomington?

Author Todd A. Strong

In Illinois, workers’ compensation doctors are paid through a fee schedule that is established by the state’s Workers’ Compensation Commission. The fee schedule sets out the maximum amount that a doctor can be reimbursed for each service he or she provides to a workers’ compensation patient.

Young doctor and businessman have a meeting
Young doctor and businessman have a meeting

Payment for medical treatment of work injuries is typically made on a fee-for-service basis. Therefore, the doctor is paid for each examination or treatment provided to the injured worker. The fees are determined by the Illinois Workers' Compensation Commission's medical treatment fee schedule, which sets the maximum amounts that can be paid for specific medical services.

Who Chooses the Workers' Comp Doctor?

According to the Illinois Workers' Compensation Act, an injured worker in Bloomington has the right to choose a treating physician from a list of approved providers. The employer is required to provide a list of at least six qualified medical providers to the injured worker. 

If the worker chooses a doctor who is not on the employer's approved list, the employer may object. In these cases, the Illinois Workers' Compensation Commission will make the decision on whether the employee's chosen doctor should be used.  

In some cases, the employer may have a preferred provider network (PPN), and the worker may be required to select a doctor from that network. If the employee is not satisfied with the medical care provided by the doctor in the PPN, he or she has the right to change doctors once during the course of his or her treatment.

It's important for injured workers in Illinois to understand their rights and responsibilities regarding the choice of doctor in a workers' compensation case. They should choose a doctor who they trust and feel comfortable with, and who is qualified to provide the medical care they need. If you are struggling to find an approved doctor you can trust, you may wish to seek the assistance of a Bloomington workers’ compensation lawyer.

Will My Workers’ Comp Doctor Be Honest?

If you suspect that your workers’ comp doctor has been dishonest, you may be wondering why workers’ comp doctors lie. Insurance carriers are experienced in defending or minimizing workers’ compensation injuries. In some cases, insurance carriers may try to select medical providers who they feel will give biased medical opinions which minimize injuries. 

Some doctors may not accurately report or document an injury in a workers' comp case due to pressure from the employer or insurance company, lack of expertise in the area of occupational medicine, or even personal biases. It is important to seek medical attention from a reputable healthcare professional and to advocate for one's rights in a workers' comp case.

Who Pays the Workers' Comp Doctor?

The responsibility to pay the doctors for the cost of treatment in workers’ compensation cases ultimately falls on the employers or their insurance company. The employer is the one responsible for paying for workers’ comp insurance. Employers may purchase this insurance through either state-run insurance programs or private insurance companies. 

Despite whether it is state-run or private insurance, the workers’ comp insurance company should pay the medical bills immediately and should continue to pay as long as the patient is receiving treatment and the claim is open.

How Do Workers' Comp Doctors Get Paid?

In Illinois, workers' compensation doctors are paid through a fee schedule that is established by the state's Workers' Compensation Commission. The fee schedule sets out the maximum amount that a doctor can be reimbursed for each service he or she provides to a workers' compensation patient.

Typically, a workers' compensation doctor will bill the insurance company that is providing coverage to the injured worker. The insurance company then pays the doctor based on the fee schedule. If the doctor's fee exceeds the amount allowed by the fee schedule, the insurance company may negotiate a lower fee or deny payment.

In some cases, the doctor may choose to accept the fee set out by the fee schedule as full payment for his or her services. In other cases, the doctor may choose to accept less than the fee schedule amount in order to ensure payment from the insurance company.

Getting Your Medical Bills Paid Through Workers' Comp

In Illinois, if you are injured on the job, your medical expenses should be covered by your employer's workers' compensation insurance. Here are the steps you should follow to get your medical bills paid through workers' compensation in Illinois:

  1. Report the injury to your employer: As soon as possible after the injury, report the injury to your supervisor or human resources department. Illinois workers’ comp law requires that workplace injuries be reported within 45 days of the worker realizing the cause of the injury. It is a good idea to keep detailed notes about the accident, any witnesses to the accident, and who you reported the accident to.
  2. Seek medical treatment: You will need to inform the doctor that the injury was work-related and that you are seeking workers' compensation benefits.
  3. File a claim: Your employer should provide you with the necessary forms to file a workers' compensation claim. Complete and return the forms as soon as possible.
  4. Attend a medical examination: If your employer disputes your claim, you may be required to attend a medical examination with a doctor chosen by the workers' compensation insurance company.
  5. Wait for a decision: The Illinois Workers' Compensation Commission (IWCC) will review your claim and make a decision on the matter. If your claim is approved, your medical expenses should be covered by the workers' compensation insurance.

What If My Workers’ Comp Claim Is Denied?

If your workers’ compensation claim is denied, you have the right to appeal the decision. An experienced workers' compensation attorney can help you navigate the appeals process.

Understanding how workers' comp doctors get paid and navigating the claims process can be complex and time-consuming. If you have any questions or concerns about your claim, it may be helpful to seek the advice of an experienced workers' compensation attorney.

About The Author

Photo of 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.