What Happens if I Miss a Physical Therapy Appointment or Doctor’s Appointment for My Workers’ Compensation Injury?


Question: I injured my right shoulder at work a few months ago. The employer gave me a list of doctors and I selected my workers’ compensation physician. So far I have treated three times for the injury and undergone a shoulder MRI, but I missed the last doctor’s appointment. Will I lose my workers’ compensation benefits because I missed the doctor’s appointment?


Virginia Code Section 65.2-603 requires an employer to provide an injured worker with medical treatment when the worker has suffered an injury by accident arising out of and in the course of the employment. The employer and its workers’ compensation insurance carrier are responsible for the payment of medical expenses that are reasonable, necessary, and related to the work injury.


The employer and its insurance carrier are not the only parties with obligations under Virginia Code Section 65.2-603. An injured worker also has certain responsibilities. For example, an injured worker cannot unjustifiably refuse medical treatment provided by the employer. If he or she does, then the employer and insurer may stop the payment of compensation (temporary total disability benefits or temporary partial disability benefits) until the worker cures the refusal of medical care.


When you miss a medical appointment, either a physical therapy visit, a doctor’s appointment, or a scheduled x-ray or MRI, then the employer and insurer can argue that you are refusing medical treatment by failing to attend an examination. The insurance company may file an employer’s application for hearing to suspend benefits on this ground. This puts your wage loss benefits at risk.


The rest of this article discusses what you should do if you are unable to attend a doctor’s appointment or have already missed a doctor’s appointment for your workers’ compensation injuries. The goal is to avoid having the insurance company file an application to stop your benefits because you missed an appointment or medical examination. You can do this by being proactive prior to the appointment and by rescheduling it quickly if you’ve already missed it.


What to Do if You Cannot Attend a Scheduled Medical Appointment for Workers’ Compensation


If the insurance company, your treating physician, or another medical provider has scheduled a medical appointment that you are going to miss due to another appointment or scheduled event, then you should notify the medical provider and insurance adjuster as soon as possible. We even recommend sending a courtesy copy of the letter or email to the Commission. By providing advanced notice of the scheduling problem to the insurance company, you seem reasonable and reduce the likelihood that the Commission will suspend your benefits based on a refusal of medical treatment.


If you are unable to attend a medical appointment due to lack of transportation, you should likewise notify the insurance adjuster that you need transportation as soon as possible. By law the employer and its insurance carrier must provide transportation to your medical appointments if you do not have it – or else they give up the right to try to suspend your benefits based on the refusal to obtain medical care.


What to Do if You Have Already Missed a Medical Appointment for Workers’ Compensation


Here is what you should do if you have already missed your PT or doctor’s appointment and the insurance company is trying to stop your workers’ compensation payments:


1. Check to see if you received notice of the medical examination. An employer or insurer seeking to suspend indemnity benefits based on a worker’s failure to attend an examination must prove that the worker received notice of the examination. If you did not receive notice of the appointment then the Commission will deny the employer’s application to suspend benefits. Likewise, you must have received reasonable notice of the appointment. The insurance company’s argument is weak if it sent you notice on the day of the appointment.


2. Contact the health care provider’s office and ask to reschedule the medical appointment. This is important for two reasons: 1) It shows that you are trying to cure your failure to attend the medical examination and 2) The employer and its insurance carrier will have difficulty persuading the Workers’ Compensation Commission that you are refusing medical treatment if you attend the rescheduled doctor’s appointment and resume care for your work-related injuries.


3. Contact the insurance company and notify them that you have rescheduled your appointment. This is important because it puts the insurance company on notice that you are curing your failure to attend the medical examination and plan on resuming care.


4. If the doctor refuses to let you reschedule the medical appointment, notify the insurance claims adjuster and ask him or her to call the doctor and authorize the payment or to provide you with a new panel of physicians. It is important that you re-establish medical treatment for your injuries.


It is ok to follow the steps above by telephone, but make sure you that send a follow-up letter or e-mail to the doctor or workers’ compensation insurance adjuster memorializing and summarizing your telephone discussion. Documentation will help you win your case at the workers’ compensation hearing if the insurance company denies that you tried to re-establish care.


Need Help with a Workers’ Compensation Case?


You should always attend scheduled therapy and medical appointments for your workers’ compensation injury. Missing an appointment puts you at risk of losing income that you and your family need to survive.


We understand, however, that mistakes happen. And if the insurance company is trying to punish you for a missed appointment, we’ll do everything we can to fight back so that you continue to receive payment. All you have to do is call us.


Need help with a Virginia workers’ compensation matter? Trying to negotiate a top dollar workmens’ comp settlement? Then contact Corey Pollard, voted one of the best workers’ compensation lawyers in Virginia, for a free consultation.