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Can I See My Own Doctor for My Workers’ Compensation Claim?

June 7, 2019 by Jason Carpenter

Injured woman asking lawyer why she can't see her doctor for check-up.

This is a question that I am asked almost every day of my practice, and the answer is not a simple one.  It is worth discussing how medical providers are generally selected and what your rights are as an injured worker.  

Every case in Workers’ Compensation has what is known as an Authorized Treating Physician, also known as the ATP.  The selection of the Authorized Treating Physician is typically a source of contention at the beginning of a case. There is no secret as to why.  It is generally in the interest of the insurance company to have a doctor that is known for providing limited treatment while the case is proceeding, and being very stingy with medical care into the future.  This is of course primarily driven by their desire to keep costs down. Conversely, an injured worker typically wants a doctor that is going to exhaust all possible treatment before medical care is terminated.  The reality is that Doctors are like politicians. Some lean to the side of big business, in other words, the insurance company, and others lean towards the American worker.

What is a Designated Provider List?

The law surrounding this issue, while appearing on its face to be very straight forward, has been interpreted by our courts to have some unusual results in many scenarios.  Once you report an injury to your employer, they are supposed to provide you with a Designated Provider List (DPL). The law states that this list must have at least four different options for medical treatment, and there must be two distinctly different owners of the facilities.  For example, you can’t provide a list with four different Concentra locations, but you could have two Concentra locations and two Midtown locations.

The reality is that many employers do not comply with this rule.  The most common thing I am told by a client is that, “my boss told me to go here for treatment.”  This is certainly a violation of a plain interpretation of the law, and theoretically, the right to select a physician should, at that time, pass to the injured worker.  The other option is that when a list is provided, you have a right to request a one-time change to any other provider on the list. Most people do not know about this rule, and often, they do not seek legal advice until after the 90 day period has passed.  This is one reason why it is absolutely essential to seek an attorney early in your case. Once 90 days has passed, changing your physician is extremely difficult.

Why Is It a Bad Idea to Select Your Own Primary Care Physician?

In the instances where a list is not provided, we often do get the right to select a doctor of our choosing.  So why is it a bad idea to simply select your own primary care physician? The reason is that in order for a doctor to assign an injured worker an impairment rating, they must be “Level 2 Accredited” which is a separate certification with the state.  Most doctors frankly don’t have this accreditation, especially if Workers’ Compensation is not the focus of their practice. As your impairment rating is the primary source of monetary value in a Workers’ Compensation case, it’s important that your ATP is able to provide one.  As impairment ratings can be largely subjective, it is also important that you negotiate a change of physician as early as possible.

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