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Does the workers comp insurance co. have the right to choose a doctor for me after the 90 days are up?

Brackenridge, PA |

My workers comp doctor done surgery on me and after 2 months he had said he cant treat me any more. He has been treating me for 4 months and refered me to another doctor at a pain management clinic at which time I have been wanting to get back into PT. My Workers comp insurance co. told me they were choosing a doctor for me to get their opinion on my condition even after my 90 days were up in march 2012. It is now may 2012 and I was injured on december 14th 2011 and was being treated since. I called and said I wanted a doctor of my choosing and they said no they want me to go to a doctor of their choosing. I dont want to go to another one of their doctors! Do I have to by law?

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Attorney answers 6

Posted

Under the Workers' Compensation Act, Section 306(f.1)(1)(i), before an injured workers is required to treat with an employer-designated medcal provider, the employer must provide the injured worker a notification of the employee's rights and responsibilities and duties and a panel list of providers is given. The employer must then obtain the injured worker's signature, both at the time of hire and at the time of injury.
***Once the employer complies with the Act, the injured worker must then treat with one of the panel providers for 90 days from the date of the first visit of one of the medical providers on the panel list.
Following the 90 days, the injured worker is permitted to treat with any doctor outside the panel list.
As an injured worker, it is important to have a Doctor who is impartial and who is treating you as the patient, not because of the Insurance Company.
Good luck

John Francis Kennedy

John Francis Kennedy

Posted

Very good answer, Attorney Townsend is very adroitly telling you the law that applies, and it gets very specific factually in each case. The insurer might also file a petition to force you to see an "IME" doctor. Plus, surgery can complicate the picture. Some judges might allow another IME after surgery.

Alexis Berg-Townsend

Alexis Berg-Townsend

Posted

I agree with Attorney Kennedy. The workers' compensation law is so fact specific. The best advice is to seek legal counsel so you are fully aware of all your rights. Remember, the Insurance Company knows their rights, make sure you are on a level playing field.

Asker

Posted

Thank you. Yes this is an independent doctor they want me to see. I just dont want them to make me return to work until I am healed or at least in better condition than I am in right now. It was like pulling teeth to get into physical therapy. I felt that being confined to my home and to my bed on many occasions was not proper treatment as I started getting worse. I need to get up and be able to move and bend more freely without this type of pain. Thats why I demanded to get to PT. By the way I had ruptured my L4L5 disc and had a partial microdisectomy and I still believe there is nerve damage as the pain is still down the leg along with very bad muscle spasms. I just want to get back on my feet and live a normal life.

Alexis Berg-Townsend

Alexis Berg-Townsend

Posted

As Attorney Kennedy mentioned before, The employer/insurance carrier has the right to send you to an Independent Medical Examination (IME) Usually, 2 per year, if the carrier decides. If you do not go to the IME, your benefits can be suspended and a Petition to Compel you to go to the examination will be fired. Again, my best advice to you is to seek legal counsel NOW!!! Too much can happen once an IME has taken place.

Asker

Posted

Will do. Thank you for your advice. I greatly appreciate it.

John Francis Kennedy

John Francis Kennedy

Posted

Very sorry to hear about your condition. That is a bad injury. Please call a lawyer. Call several. Any lawyer that has answered on this page is excellent.

Posted

If you were injured in Pennsylvania, and assuming the Pennsylvania law applies, the insurer is allowed to have you examined generally once every 6 months by a so-called "independant" medical examiner. In my opinion, the insurer is not allowed to chose your medical provider after 90 days (and technically speaking even in the 90 day time perdiod after an injury you can treat with anyone that you want to treat with, but the insurer might not be responsible to pay the medical bill.)

But in answer to your specific question: Does the insurer "have the right to chose a doctor for me after...90 days" I would say they can, but only for an IME (independant medical exam). That is a one time exam that the insurer is allowed to get (usually) every 6 months. They don't have the right to chose your surgeon, and they don't have the right to pick the doctor that you can see on a regular basis for treatment. In fact, an IME doctor will usually tell you up front when he does the IME exam that s/he is not your treating doctor and there is no "doctor-patient" relationship.

You really should talk to a lawyer that specializes in workers compensation cases. Most of us will not charge you any fee for a telephone call to talk about your case. Call several lawyers, and find one who you feel comfortable with. Your case is too important. Good luck.

Posted

Ninety days after your injury you have the right to choose your doctor, and the insurance company is required to pay for it. You control your treatment, not them. Approximately twice a year they have the right to subject you to an Independent medical examination with a doctor of their choosing, otherwise you decide which doctors you will go to.

Posted

The simple answer is - No. After 90 days you may treat with a doctor you choose and workers' comp will pay for the treatment so long as it is reasonable and necessary treatment for the work injury. You should choose your Doctor wisely because he or she may have to support you and testify on your behalf at some point in the future. Also, many people feel limited because they "only" have workers' compensation to pay for their medical treatment. This should not be the case. You should treat your workers' comp coverage just like Blue/Cross and Blue Shield. You have the right to choose your treatment provider and get treatment. Workers' Comp is obligated to pay for appropriate treatment in full. There are no co-pays or deductibles for you to worry about. In this aspect it can actually be better than private insurance. Good luck

Robert P. Frantz

Robert P. Frantz

Posted

I agree with the other commentators regarding the independent medical examination. There is a big difference between between treatment and the independent exam. The ime will not provide any treatment at all. It will be an exam to assess the status of your injury by a doctor chosen and paid by the carrier. You must go or you could risk your wage benefits if you refuse to go and the workers' comp carrier files a petition to compel your attendance. Good luck

Posted

No.

John Francis Kennedy

John Francis Kennedy

Posted

Gotta love the short and sweet answer.

Posted

All the answers to your question so far are spot on. There is, however, one thing to add: you don't always have to treat with your employer's choice of doctor DURING those first 90 days. You can escape the "captive period".

As Attorney Berg-Townsend pointed out, an employer must jump through some hoops to compel you to treat with their doctors for 90 days. They must post a list of physicians from which to choose, AND they also have to have you sign a workers' compensation document at hire and after your work injury.

If the employer has not jumped through these hoops, an injured worker may choose from outside the employer's list and escape the "captive period".

The answer to this question is based on Pennsylvania Law only. Workers' Compensation statutes and case law vary from state to state.

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