How to Schedule a Workers Compensation Doctor’s Appointment in Virginia
Scheduling a workers’ compensation doctor’s appointment should be easy. All you should have to do is call the doctor’s office, ask for available dates for an appointment, and attend the appointment. But if you’ve been dealing with the workers’ compensation claims process for any period of time, you know that nothing is straightforward with Virginia workers compensation.
Making a doctor’s appointment through Virginia workers’ comp is more difficult than using your private health insurance to see the doctor. But before we talk about scheduling a workers’ compensation doctor’s appointment, let’s go over the types of medical treatment covered by workers’ comp in Virginia.
What Medical Treatment Does Workers’ Compensation Cover in Virginia?
If an injured employee proves that he or she suffered an injury by accident arising out of and in the course of their employment, as those terms are defined by the Virginia Workers’ Compensation Act, then the employer and its insurance carrier must pay for all reasonable and necessary treatment related to the work injury. The entire cost is covered by the workers’ comp insurance company. You do not pay any co-pay, deductible, or co-insurance for reasonable and necessary medical care related to your injuries.
There is, however, a catch. Virginia workers’ compensation law limits who you may treat with. You must choose a doctor from the panel of physicians offered by your employer and its insurance carrier. If you refuse to see one of those doctors, and treat with a doctor who is not on the list, then that treatment is unauthorized and the Workers’ Compensation Commission may not make the insurance company pay for it.
Your authorized treating physician may recommend or prescribe any medical treatment, diagnostic testing, or pain management that is reasonable and necessary to treat your work injury.
This is a summary of workers’ compensation medical treatment in Virginia. Please visit our article on workers’ compensation medical issues for additional information that can help you throughout your workers compensation claim.
Why is it Difficult to Schedule a Workers Compensation Doctor’s Appointment?
Like most of us, doctors want to know that they will get paid for the services they provide. If a doctor doesn’t know how you will pay for an appointment, then he or she likely won’t see you.
But wait! The Workers’ Compensation Commission has entered an Award Order providing me with lifetime medical benefits for all reasonable, necessary, and authorized medical treatment related to my work injury. Isn’t that good enough?
It should be. But like you probably are, doctors are wary of the workers’ compensation insurance carrier. They know that an insurance carrier may dispute the reasonableness or necessity of medical treatment at any time. And if this happens after the doctor has provided treatment, then the doctor may not get paid for his or her services.
When you call to schedule a schedule an appointment, the doctor’s office will ask you for the name of the workers’ compensation adjuster or nurse case manager assigned to your case, as well your claims number and case number. It’s ok to give this information to the doctor’s office. You should.
The doctor’s office will then try to get approval from the insurance adjuster. Without confirmation from the adjuster, some doctor’s offices may not allow you to schedule the appointment. As a result, you will not get the medical treatment you need when you need it. No response from the adjuster is the same as a medical treatment denial.
Does the Insurance Company Have to Give Approval to the Doctor’s Appointment?
No. The Virginia Workers’ Compensation Act does not require the insurance company or the nurse case manager to give approval to the doctor’s office when you’re trying to schedule the appointment.
How Do I Get a Workers’ Compensation Doctor’s Appointment Scheduled?
The first step in scheduling a workers’ compensation doctor’s appointment is to call the doctor’s office and ask for an appointment. The office may go ahead and schedule the appointment. That’s great.
But sometimes the doctor’s office will say that approval is needed first.
Most doctor’s offices are good about contacting the workers’ compensation insurance company to get approval. But others aren’t. Either you or your workers’ comp attorney can try to speed up the approval process by contacting the insurance adjuster, nurse case manager, or defense attorney. Ask them to contact the doctor’s office and provide approval for this appointment.
It’s important that you document your efforts in trying to get the appointment approved. You can use this documentation to show that the insurance company acted in bad faith at a later hearing, or if you need to convince the Commission to order the insurance company to pay for treatment with an unauthorized medical provider because it refused to authorize the doctor’s appointment.
By being proactive, you increase the chance of getting your workers’ compensation doctor’s appointment scheduled in a timely manner. But sometimes informal efforts are not enough.
What Do I Do if I Need Help Getting Medical Treatment for My Workers’ Compensation Injury?
Unfortunately it can be difficult to get the medical treatment you need after a work injury. In fact, denied medical care is one of the most common reasons that injured employees call me.
Even injured workers who have no problems getting appointments scheduled may run into difficulties when the doctor wants to perform a surgical procedure or run an expensive diagnostic test. But we can help.
Call, text, or email me if you’re having trouble scheduling a workers’ compensation doctor’s appointment. We have experience dealing with insurance companies, employers, and third-party administrators who do everything they can to delay and deny much needed medical treatment that is reasonable, necessary, and related to the work accident.
Call Corey Pollard now for a free strategy session. Your consultation is free. And you pay no attorney’s fee unless we recover benefits on your behalf.