If I Am Initially Treated By An Insurance Company Doctor Do I Have A Right To See My Own Doctor

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Since worker's compensation laws are designed as a compromise between the employer and the employee, the employer or claim adjuster is obliged to both select and arrange payments for the injured employee's initial care. Because of this, personal health care providers will generally refuse to treat a patient for work-related injuries and illnesses. Additionally, personal health insurance will refuse to pay for services for such issues.

The employer-appointed physician examines and treats the employee, then makes a full report back to the employer or claim adjuster. It is understandable that an injured employee might feel that a diagnosis, prognosis, or treatment plan coming out of such an arrangement is likely to be slanted in the direction of the employer's best interest. The employee has the right to request a different doctor or a second opinion if he or she does not agree with the initial provider's report, and may do so at any time during the claim process. However, the employer or claim adjuster must approve the change or additional care in advance and make arrangements for payment with the new provider. Not following the rules that stipulate the medical care process can be a very costly mistake to the employee in the administration of a claim. You have the right, if represented by an attorney, to request that a Primary Treating Physician's Progress Report after each appointment to be sent to you.

If an employee is worried about termination because of a change in physician, or if they have already been terminated, a case can be brought forth for termination with no justifiable reason. The insurance company does not have leverage of having the ability to cut off temporary total benefits.

The treating physician's report weighs heavily on decisions made in the claim process, so it is important that the employee not view this doctor with the same regard as his or her personal physician. Treatment for any other illnesses, injuries, or issues that are not directly related to the worker's compensation claim should continue to be handled by the employee's personal health care team. It may seem convenient and cheaper, while being seen by the occupational physician, to have other issues taken care of at the same time. However, any additional health information disclosed to the workers compensation appointed medical team may become part of the injury report and, subsequently, part of the decision on the claim.

Many states' worker's compensation laws allow for medical care to eventually revert to the employee's personal provider. The timeliness of the choice to transfer care is important and guidelines must be strictly adhered to. It is in the employee's best interest to be fully informed of the specifics of the law in this issue before making decisions about future care.


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