Health care providers play an important role in the Virginia workers’ compensation process. Their medical records and reports are pieces of evidence in your case. This article discusses how you choose a doctor for workers’ comp and when the employer must offer you a panel of physicians. Often we get asked, “What can I do if my case is accepted but I don’t like my doctor?” Read on and you’ll know the answer.
Your Employer Should Offer You a Panel of Physicians after the Work Accident
Virginia Code Section 65.2-603 requires that the employer provide the injured employee with a panel of physicians from which to choose. The employer should offer the panel soon after you report your work-related accident.
The panel must have at least three physicians. If it contains the names medical facilities, or less than three physicians from which to choose, then it may be a defective panel. Also, the physicians must not be with the same practice group. They should be independent.
If the panel of physicians is defective the insurance company must offer a new panel, or you may be allowed to choose your own doctor. Do not make the decision to treat on your own without speaking with a workers compensation lawyer first.
So who gets to choose the doctors on the physician panel? Your employer and its workers’ compensation insurance carrier. Neither you nor your attorney get to choose who is on the panel of physicians, though your attorney may try to make suggestions to the insurance carrier.
Your Employer Must Pay for Treatment Provided by the Doctor You Choose from the Panel of Physicians
The physician you choose from the panel because your authorized treating physician. Your employer or its workers compensation carrier are responsible for payment of the following:
- Charges billed by your authorized treating physician
- Charges billed by any medical provider to whom you are referred by your authorized treating physician
- Prescriptions written by or at the direction of your treating physician
Your employer is also responsible for charges for reasonable and medically necessary diagnostic procedures – even if the diagnostic measure determines that your condition is not related to a compensable injury by accident or occupational disease. The employer must pay for the diagnostic measure when it is performed to determine whether your condition is related to a compensable injury, how severe your injury is, or whether you need additional treatment such as surgery.
Then your employer and its workers compensation carrier may have to provide you with a panel of specialist physicians from which to choose. If your authorized treating physician refers you to a specific doctor or physician for speciality care, then your employer must pay for care with that specific specialist. If however your authorized treating physician refers you to a specialist without naming a specific medical provider, then your employer will have to offer a panel of specialists.
electing a doctor from the panel is one of the most important decisions you’ll make during your Virginia workers’ compensation claim. Though your employer and its workers’ comp insurance company may start off giving you every benefit you’re owed, disputes often arise when the injury is severe and results in the need for surgery and lost time from work. If litigation is necessary to get your workers’ comp benefits, then the Virginia Workers’ Compensation Commission will review your authorized treating physician’s records and reports to make a decision. In most cases, your treating physician is the most important person.
Because your treating physician’s opinions are so important, you want to select a claimant-friendly doctor from the panel. An experienced workers compensation lawyer will know the reputations of the doctors on your panel. There are three factors that I evaluate when determining which doctor my client should choose from the panel:
- Skill and Ability: Regaining your health is your top priority. The doctor you choose should be competent and capable of providing high-quality medical treatment.
- Cooperation: I spend a lot of time talking with my clients’ doctors. You want a doctor who is willing to speak with your attorney free of charge and to answer questionnaires and draft narrative reports that support your claim. We often ask doctors for their opinions on causation, disability, and permanent partial disability.
- Work Restrictions: Some doctors are more conservative than others when it comes to issuing work restrictions. When you have work restrictions, your claim is more valuable. If a doctor is conservative on work status, then he or she may release you to return to work before you are ready physically.
So before you pick the first name on the doctor panel or the office closest to home, contact an experienced work comp attorney to evaluate your choices. Your treating physician will have a significant impact on your right to wage loss benefits, whether recommended medical treatment is approved, and even the value of the Virginia workers compensation settlement you receive. Don’t take this decision lightly.
I don’t like that you have to treat with a workers’ comp panel doctor. I think you should be able to choose your own doctor, someone you’ve researched and are comfortable with. But the Virginia Workers’ Compensation Act doesn’t allow that in most cases.
If you refuse to treat with a panel doctor, the commission will not make the insurance company pay for that treatment. You may be left having to pay for the charges from that doctor. If you are under an award order and stop treating with your work comp panel doctor, then the employer may file an application to suspend benefits based on a refusal of medical treatment.
There are some exceptions to this rule. If the insurance carrier waits too long to give you a panel of physicians, you may choose your own doctor. Likewise, you can treat with your own doctor if the panel physician is providing inadequate care. Often there is a dispute as to whether the care is reasonable or whether your employer offered a timely panel. Speak with an attorney before making any assumptions.
When you’re hurt on the job in Virginia, you need someone in your corner. We are here for you and your family. Call or e-mail us for a free consultation.