Can I Choose My Doctor Under Workers Compensation in Virginia?

 

Medical providers play an important role in the workers’ compensation claims process. Their opinions, as stated in medical records, reports, and other documents, are key pieces of evidence at workers compensation hearings.

 

Your workers’ compensation doctor’s opinions also help determine the amount of temporary total disability and permanent partial disability benefits you receive, as well as the value of your workers compensation settlement.

 

Virginia workers’ compensation laws allow you to pick your workers’ compensation doctor. But you have a limited number of doctors to choose from. The doctor you can choose to treat your workers compensation injury will depend on whether your employer and its insurance carrier have followed the rules about offering a workers’ compensation list of doctors, also referred to as a panel of physicians.

 

This article explains how to choose a doctor under workers compensation in Virginia so that you give yourself the best chance of a full physical and financial recovery. Please keep reading to learn more about the workers compensation panel of physicians, then contact Virginia workers comp lawyer Corey Pollard for a free consultation.

 

Do The Employer and Its Insurance Company Control Medical Treatment in Your Workers Compensation Case?

 

We speak with injured workers every day. And many tell us that their employer or its insurance carrier told them to go to a specific doctor or else the worker would have to pay for their own medical treatment. The employer and insurance company act like they have complete control over medical treatment.

 

This is not true.

 

Virginia workers compensation law gives your employer and the insurance company limited input into who you choose as your workers’ compensation doctor, also referred to as the authorized treating physician.

 

In fact, the employer and its insurance carrier’s role in workers’ compensation medical issues is limited to providing a list of workers’ compensation doctors. This list is called a panel of physicians. The employer and insurance company can limit your choices when it comes to picking a workers compensation doctor, but that is all the control they have. You can to choose which doctor on the panel of physicians will be your workers compensation doctor.

 

Your Employer and the Insurance Company Should Offer You a Panel of Physicians from Which to Choose a Treating Doctor for Your Work Injury

 

Section 65.2-603 of the Workers’ Compensation Act requires your employer to provide you with a panel of physicians from which to choose. They get to choose the doctors on the list, subject to certain rules. Neither you nor your attorney can choose which doctors are put on the workers compensation panel of physicians, though your attorney may make suggestions to the insurance adjuster or defense counsel.

 

The employer or its insurance company should offer the panel of physicians soon after you report your work-related accident and injury. The longer they wait, the better the chance you can pick your own doctor, which is good for your workers’ comp claim.

 

The panel of physicians must contain at least three doctors who are independent. This means that the doctors on the list should not be affiliated with or part of the same practice. If the panel contains less than three independent doctors, then it is defective under the Workers’ Compensation Act.

 

If the panel of physicians is defective, the employer or its insurance company must offer a new panel from which to choose your treating doctor.

 

When the employer and its insurance carrier fail to follow the rules or to remedy a deficient panel, then you may be able to pick any doctor that you want to serve as your authorized treating physician for your workers’ compensation case. But talk to an attorney before deciding to treat with a doctor who is not on the insurance company’s list. A wrong decision here could lead to thousands of dollars in medical bills that you are responsible for.

 

How Can an Attorney Help Me Choose a Workers Compensation Doctor from the Panel of Physicians?

 

As a workers’ comp attorney, I help injured employees across the state pick the best physician from the panel of doctors offered. Selecting 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 wage loss 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 workers compensation doctor from the panel of physicians. 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 workers’ comp 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.

 

  • Causation and Work Restrictions: Some doctors are more conservative than others when it comes to causation and issuing work restrictions. When you have supportive evidence on causation and 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 make this decision lightly.

 

Your Employer and Its Insurance Company Must Pay for Medical Treatment Provided by or at the Direction of the Doctor You Choose from the Panel of Physicians

 

The doctor you choose from the panel because your authorized treating physician for the entire workers’ comp case, with some exceptions. Your employer or its workers compensation insurance carrier are responsible for payment of the following:

 

  • Charges billed by your authorized treating physician for reasonable and necessary medical treatment

 

  • 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.

 

What About Referrals to Other Medical Providers for My Work Injuries?

 

Many employers and insurance companies try to control referrals to other health care providers and facilities, even though they are not allowed to medically manage your case.

 

For example, the insurance company may tell you that you have to go to a specific diagnostic center to get an MRI or that you must see a specific physical therapist or else they won’t pay for treatment. We’ve even seen insurance companies try to control where injured employees get their prescriptions filled..

 

Usually the insurance company tells you that certain doctors or health care providers are not in their network, so you must follow their direction on referrals. But this isn’t true. The fact that a specific medical provider or health care facility is not “in network” is the insurance company’s problem, not yours.

 

Under Virginia workers compensation law your authorized treating physician controls all aspects of your medical care. He or she gets to pick the doctors, therapists, and other health care providers that you see. The insurance company’s network doesn’t matter.

 

Remember: The authorized treating physician controls your medical treatment, not the insurance company.

 

What if My Authorized Treating Physician Gives Me a General Referral, Not a Specific Referral?

 

Sometimes an authorized treating physician will refer a patient to a specialist, but not identify what specialist should be seen. This is called a generic referral.

 

If your treating physician gives you a generic referral to a specialist, then the insurance company must provide a new panel of physicians that contains at least three specialists from which to choose. The insurance company cannot give you just one option. It must offer a new panel that satisfies the Workers’ Compensation Act.

 

Can I Pick My Own Workers Compensation Doctor if the Authorized Treating Physician Releases Me from Care?

 

Your treating physician may tell you that you have reached maximum medical improvement and that he or she has nothing else to offer you.

 

In this situation you should ask the insurance company to offer you a new panel of physicians. You must give the insurance company an opportunity to do the right thing. If it refuses, then you can pick your own workers’ compensation doctor.

 

What Happens if I Refuse to Treat with a Doctor on the Workers Compensation Panel of Physicians?

 

I don’t like that the Workers’ Compensation Act allows the employer and its insurer any input over who you choose as your workers compensation doctor. I think that you should be able to choose your own doctor, someone that you have researched and who you are comfortable with. But the law doesn’t always allow that.

 

If the insurance company follows the rules and offers you a panel of physicians in a timely manner, then there are consequences if you refuse to treat with the panel doctor. The Workers’ Compensation Commission will not force the employer or insurer to pay for charges from that doctor. So you may be left having to pay for charges, which are sometimes in the tens of thousands of dollars.

 

If you are under an award for medical benefits and stop treating with the doctor from the workers’ compensation list, then the employer may file an application to suspend benefits based on a refusal of medical treatment. This can affect your wage replacement benefits.

 

There are some exceptions to these rules, which were discussed above. Make sure you talk with an attorney before changing to a new workers’ compensation doctor.

 

Can I Pick My Workers’ Compensation Doctor if the Employer and Insurer Do Not Offer a Panel of Physicians?

 

Yes. If the employer and its insurance carrier refuse to offer a panel of physicians, or if they deny your claim for medical benefits for your work injuries, then you can pick your own workers’ compensation doctor.

 

In this situation you will have to use your own private health insurance or pay out of pocket to get treatment. And you will not be reimbursed unless you go to a hearing in front of a deputy commissioner and receive an award for medical benefits. If you prevail at hearing, then the workers compensation insurance company will have to continue to pay for treatment rendered by or at the direction of the doctor you chose for your work injury.

 

Have Questions About Workers’ Compensation?

 

Workers’ compensation is frustrating, confusing, and complex. But we can help. If you’re an injured worker in Richmond, Chesterfield, Hanover, Petersburg, Williamsburg, Hampton, Newport News, Fredericksburg, Norfolk, Chesapeake, Virginia Beach, Fairfax, or Prince William County, contact Corey Pollard for a free strategy session. We’ll help you with every step of the workers’ comp claims process, including picking the best doctor for your work injury.