Can I Choose My Own Doctor for a Work Injury?
No one plans to get injured on the job, but according to the Bureau of Labor Statistics, that is exactly what happened to 2.6 million workers across the country who were injured on the job in 2023 (the most recent data).
Many of those injured workers were able to take advantage of their employer’s workers’ compensation insurance program to get reimbursement for medical expenses and lost wages.
Before workers’ compensation insurance pays out for any medical benefits, the extent of the injury needs to be confirmed by a doctor. Although you may not plan to get injured on the job, it is essential to have a plan in place for seeking medical care. Can you choose your own doctor for a work injury?
The answer to that depends on where you live and what healthcare programs are in place.
Why an Insurance Doctor Might Not Offer the Best Support
You never want to think that something nefarious is going on with a doctor who is supposed to be providing care. However, when a workers’ compensation insurance carrier gets to choose your doctor, that doctor might not always be working in your best interests.
A doctor hired by an insurance company might lean towards prescribing the most cost-effective treatment rather than the best course of treatment for your injury.
That same doctor might also push to designate you as reaching your maximum medical improvement (MMI) as soon as possible. That will mean you’ll be obliged to return to work, and your benefits will cease. Overall, that doctor might be more inclined to side with the insurance company and not provide any pushback when there is a denial of coverage.
In those worst-case scenarios, you would benefit from speaking with an experienced workers’ compensation attorney who can step in to become your advocate to help you get the benefits and care you need to recover.
As mentioned, each state dictates its workers’ compensation laws, and that applies to whether you can choose your own doctor. Here are some examples:
Kentucky
In Kentucky, workers generally have the right to choose their own doctor after getting injured on the job. However, there are some important caveats to be aware of. If your employer offers health insurance through a managed care program that you are part of, you might be required to choose a physician from their approved list.
Of course, you might have already seen one of those doctors as your general practitioner, so that it wouldn’t be much of an exception.
If, for some reason, you are going to one of the approved doctors and you’re not satisfied with the care you are receiving, you are entitled to switch physicians at least once without providing a specific reason. After that, there could be challenges.
Even after consulting your own doctor, your employer or their workers’ compensation insurance carrier may require you to see a doctor of their choice for an independent medical examination (IME). Think of this as a second opinion. An IME shouldn’t negate the findings of your doctor.
Illinois
In Illinois, an injured worker has the right to choose their own doctor for a work-related injury.
You’re also allowed to choose a different doctor if the first one is unsatisfactory. The exception is if your employer has a preferred provider program (PPP) in place as part of the company’s employee health benefits. In that case, your first choice of doctor must come from the Preferred Provider Panel (PPP) list.
Your employer is also entitled to request an IME from a doctor of their choice.
Missouri
In Missouri, your employer or their insurance carrier will choose the initial physician to treat your workplace injury. However, you can choose your own doctor, but that will mean you are responsible for all the costs. If you have private insurance, that will also limit your ability to get reimbursed.
That’s because most private insurance companies would defer to workers’ compensation if the injury happened on the job. In other words, they are going to pass the buck. Due to the potential costs of treating your injury, selecting your own doctor may not be the best option.
Ohio
In Ohio, you have the right to choose your own doctor for a work-related injury, but they have to be certified by the Ohio Bureau of Workers’ Compensation (BWC).
The good news is that most doctors, including your chosen one, will be on that list; however, it is essential to verify this before you get injured. There is an exception for the initial visit. For that, you can choose any doctor, such as one with urgent care or at an emergency room, even if they aren’t BWC-certified. After that first visit, you need to switch to the BWC-certified doctor.
It can sometimes be overwhelming to sort through all the workers’ compensation regulations when you just want treatment for an injury.
Getting a skilled workers’ compensation attorney involved early on in your claims process can provide you with the guidance and information you need to make the right decisions about how to be reimbursed for your care.
Work Injury Advisor has resources to help bring these issues into focus.
