Workers’ Compensation Authorized Treating Physician
If you have filed a workers’ compensation claim and are navigating the workers’ comp claims process, then you have probably heard the term “authorized treating physician.” Authorized treating physician is the legal term for your primary doctor in a Virginia workers’ compensation case.
The authorized treating physician will have an important role in your workers’ comp case. Not only will the treating physician prescribe and render the medical care you need to recover from your work injury, the treating physician will also provide opinions on your work capabilities and permanent partial disability.
The Workers’ Compensation Commission often follows the treating physician rule in disputed cases. The rule is simple. It states that the Commission has a general policy of giving greater weight to the opinion of a treating physician over a physician who has conducted one examination, like an IME doctor. As such, it’s important that you choose the best doctor for your work injury and establish a good relationship with him or her. Your treating physician’s opinions will go a long way toward determining the medical treatment you receive, the temporary total disability benefits you are paid, and the value of the workers’ compensation settlement you negotiate.
This article explains the role of the authorized treating physician in workers’ compensation in Virginia. If you have any questions about workers’ comp, or are looking for legal representation, contact attorney Corey Pollard for a free consultation. We’re happy to help you and your family during this difficult time.
Who Picks My Authorized Treating Physician in Workers’ Compensation?
Under Virginia law, the employer and its insurance company must offer you a panel of physicians from which to choose your treating physician. The panel must have at least three physicians in the appropriate medical specialty who are not affiliated with one another. Otherwise, the panel is invalid.
You have the right to pick your authorized treating physician from that panel. We recommend discussing the panel with an experienced workers’ compensation attorney before making your selection. Choosing an authorized treating physician is one of the most important decisions in your case. The right doctor – someone who is both skilled medically and who will stand up for you in litigation – can make a big difference in your physical, emotional, and financial recovery. And an experienced attorney can help you find that treating physician and develop a strong relationship.
Who Can Be an Authorized Treating Physician?
If your work injury requires treatment from multiple medical specialties or health care providers, then it’s possible to have more than one authorized treating physician. For example, those of you who have suffered a back injury at work may have a treating orthopedic doctor, a treating neurologist, and a treating pain management doctor in the same workers’ compensation case.
Below is a list of health care professionals who can serve as authorized treating medical providers in Virginia workers’ compensation cases:
- Doctor of osteopathy
- Licensed Clinical Social Worker
- Medical doctor
- Occupational therapist
- Physician’s assistant
- Registered Nurse Anesthetist
- Speech-Language Pathologist
As a workers’ comp attorney, I spend a lot of my time talking and corresponding with medical providers in Virginia. We can help you find the best authorized medical provider for your work injury case.
Can My Workers’ Compensation Authorized Treating Physician Change?
Yes. There are situations where your authorized treating physician may change in a workers’ compensation case.
First, your doctor may refer you to someone who has greater expertise with the type of injury you sustained. If you receive a direct referral, then this medical professional will become your new authorized treating physician. If you receive a generic referral (i.e., the injured employee needs to see a specialist), then the insurance company has the right to offer you a new panel of physicians that contains specialists. You must choose your new authorized treating physician from that panel if it is valid.
Second, your doctor may release you from care even though you continue to have symptoms. If the insurance company refuses to provide a new authorized treating physician, then you may have to file a change in condition claim seeking a new panel of physicians or a change in authorized treating physician. The Workers’ Compensation Commission will rule on your request after a workers’ comp hearing where you and the insurance company submit evidence and testimony.
Third, you may not get along with your authorized treating physician for whatever reason and want to change. Ask the insurance company if it will allow you to change to a new treating physician. If it says yes, then great. If it says no, then you will have to file a claim for a change in treating physician.
Fourth, you and the insurance company may agree to change to a new authorized treating physician for other reasons. Maybe the insurer doesn’t like dealing with the doctor’s administrative staff. Maybe it takes too long to get an appointment. Or maybe you’ve moved and do not have transportation to the current doctor’s office. No matter the reason, you and the insurer can agree to change authorized treating physicians. But make sure you memorialize the change with the insurance company in writing.
The bottom line that you should not switch treating physicians or medical provider without discussing it with an attorney first. The Commission has stated, “Once the selection of a treating physician is made, the employee is not at liberty to change therefrom unless referred by said physician, confronted with an emergency, or given permission by the employer and/or its insurer or the Commission.” So unless you take appropriate action, you may be left with expensive medical bills from unauthorized medical care.
An Authorized Treating Physician’s Power in Workers’ Compensation Cases
Your workers’ compensation authorized treating physician has a lot of power in your workers’ compensation case.
First, the authorized treating physician has the power to provide appropriate medical treatment and diagnostic testing. The Commission has stated that, “medical management of the claimant is to be directed by the treating physician, not by an employer’s representative.” In other words, the Commission will give great weight to what the treating physician has to say about your condition and what medical treatment is reasonable and necessary. If your authorized treating physician says that you need a medical procedure or surgery, then the Commission will likely order the insurance company to pay for that specific treatment.
Second, the authorized treating physician has the power to refer you to other medical specialists for the care of your work injury. For example, you may have a meniscus tear. If your authorized treating physician is a primary care physician, then he or she will want to refer you to an orthopedic surgeon so that you can get the meniscus repaired. The insurance company has to pay for these referrals under Virginia workers’ compensation law. The power of these referrals can help you recover quicker.
Third, the Workers’ Compensation Commission often gives controlling weight to what your authorized treating physician has to say about your work status. If your treating physician has stated that you’re unable to return to any type of work, then the Commission will likely enter an award order for ongoing temporary total disability benefits. If the employer offers you a light duty job but your treating physician says it is outside of your restrictions, then the Commission will likely find that you can reject the light duty job offer with no repercussions. This is why it’s important to have a fair authorized treating physician who is willing to work with your attorney on the disputed issues.
Fourth, the Commission often gives controlling weight to the opinions of the authorized treating physician regarding whether you have reached maximum medical improvement and what type of permanent partial disability you have. A fair treating physician who also serves as an advocate for his or her patient can lead to thousands of additional dollars in your pocket for the work injury.
Do You Have Other Questions About Workers’ Compensation?
I hope you found this article helpful as you try to get all the workers’ compensation benefits you deserve. But you may have more questions. Or you may want an experienced attorney to help you negotiate a lump sum settlement.
I’m happy to talk with you and your loved ones. Call, text, or email me to schedule a free strategy session. You can get more information and some answers to your questions.