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Workers’ Compensation Doctors: Do I Have to Use the Doctor Designated by Workers’ Compensation?

In 2020, the U.S. Bureau of Labor Statistics reported 2.7 million nonfatal workplace injuries and illnesses, with 1.1 million of those requiring employees to miss at least one day at work. 

If you’re one of the 2.7 million, you shouldn’t feel like a statistic. Your injury affects your ability to earn income, care for loved ones, retain your social life and carry out other essential tasks. You need excellent medical care to be whole again after an injury.

Whenever you have an injury at work in Missouri, you most likely have to go through your employer’s workers’ compensation insurance to get the medical evaluation and care that you need to recover.

You have to trust a specialist who is most likely not your primary care doctor. This person should be responsible for evaluating and treating your injury, but they are not there to advocate on your behalf.  

Most workers’ compensation doctors know they have been hired by your employer,  splitting their loyalty between you as their patient and your employer/insurer who is paying their bill. 

This is a scary and uncomfortable position. As a hardworking individual, you want to get healthy and back on track as soon as possible. A doctor picked by your employer may not have your best interest in mind.

Start a chat with us or fill out a contact form if you’ve experienced:

  • A workers’ compensation claim denial
  • An early release from treatment
  • Exacerbation of your injury by a workers’ compensation doctor

Want to learn more about the workers’ compensation treatment process? Keep reading.

Workers’ Compensation Doctors: Do I Have a Choice?

In the state of Missouri, you can go one of two ways when getting care for your work-related injury:

  1. You see the doctor chosen by your employer or their workers’ compensation insurance company; or
  2. You choose your doctor at your expense.

Why Can’t I Choose My Doctor with a Work-Related Injury?

The Missouri workers’ compensation system is designed to be a compromise between employees and employers. 

Before the enactment of the workers’ compensation system, an employee would have to prove that their employer was at fault for their injuries. 

Now, the employer/insurer must provide certain benefits, including medical care, to an injured employee regardless of fault in the accident. The employee does not have to prove fault on the employer to be entitled to workers’ compensation benefits. 

In exchange for this compromise, the employer/insurer is allowed to choose the doctor that provides you with treatment.  

If the employer/insurer your claim as being compensable, they will authorize treatment through a physician of their choice. 

You can seek a second opinion or treatment through a physician of your choice. However, if the employer/insurer is authorizing care for you, they don’t have to pay for any treatment you receive from a physician you choose. 

No one can prohibit you from seeing your own doctor, but workers’ compensation will not have to pay for that treatment if they are authorizing appropriate care.

If you elect to seek treatment outside of the workers’ compensation system, you should be aware that this often is not covered by your health insurance. 

Most health insurance plans won’t pay for treatment that should be covered under workers’ compensation. However, if workers’ compensation refuses to provide you with treatment, you can submit your bills to your health insurance.  

If you are injured due to a work-related accident, your employer is required to provide medical treatment necessary to cure and relieve you of the effects of the injury.

Missouri is, outside of a few areas of extreme negligence, a no-fault state when it comes to workers’ compensation claims. Employers offer treatment at no cost to you, but you can’t file a lawsuit against them. 

This agreement also means that your employer chooses your medical care. Your employer or workers’ compensation company doesn’t direct medical care, but they choose the physician who will handle it.

If you choose to go with the medical care elected by your employer’s insurance, you may feel like you will be at odds with the doctor or specialist you see. It’s essential to know what to say whenever you visit this doctor for the first time.

What You Should Say to a Workers’ Compensation Doctor

Whenever you see a workers’ compensation doctor, it’s essential to communicate: 

  • The cause of the accident
  • Your symptoms 
  • How the injury affected your ability to work

The doctor will set restrictions, if appropriate, designed to allow you to return to work safely. It’s important to accurately communicate to the doctor what your job duties are so they can set appropriate and safe restrictions for you.

What Not to Say to a Workers’ Compensation Doctor

Whenever the workers’ compensation doctor is evaluating you, you should avoid these things:

Embellishing your injury 

It may be tempting to embellish your injury or omit details about the accident to sell your case. However, you shouldn’t exaggerate to get the care you need. 

Doctors are trained to look for signs that a patient is exaggerating their symptoms, and if they see these signs, it can reduce your credibility with the doctor. 

If you’ve experienced past injuries, refrain from covering them up. Make sure you explain how your aches, pains and lack of mobility aren’t lingering effects from past injuries and how the symptoms of your work-related injury differ from past injuries.

If you are denied treatment by the doctor’s evaluation or the insurance company, you can speak to a lawyer to review your options. 

Speculating on your injury 

Allow the medical professional to complete their evaluation. If you believe that you aren’t getting proper treatment for your injury, contact a workers’ compensation lawyer to review your options.

Talking poorly about your employer or the insurance company

You don’t have the same confidentiality protections with your doctor while under the workers’ compensation system. 

Assume that everything you tell the doctor will be included in the medical record or reported back to the Employer and Insurer.   

Workers’ compensation medical professionals may be closely tied to the insurance company, and word can spread fast. 

If you believe that you’ve been treated unfairly during a work-related injury case, share your grievances with a workers’ compensation lawyer. 

When to Contact a Workers’ Compensation Lawyer

An experienced workers’ compensation attorney can help you get the compensation you need to cover medical expenses from a work-related injury. 

It’s critical to report your injury to your employer or human resources representative as soon as possible. 

You don’t want to miss the workers’ compensation claim statute of limitations window, which is two years from the date of the injury. Also, the further away you get from the injury, the more likely your case will be denied.

If your claim has been denied due to the medical opinion of the workers’ compensation doctor, you may want to contact an experienced legal team to see if you can appeal the decision or press for fair compensation. 

An attorney may also connect you with a medical professional who can give you a second opinion on your injury.

If you don’t think you’ve reached maximum medical improvement before being cleared to go to work, you may need to discuss your case with a workers’ compensation attorney.

Finally, if the workers’ compensation doctor worsened your injury, you need to speak with an attorney immediately. You should never have to deal with the negligence of a medical professional on top of your work status.

Workers’ compensation doctors are not considered an employer and are open to medical malpractice cases.

Contact the legal team at Eng and Woods today if you haven’t been made whole by your employer or their workers’ compensation insurance after a work-related injury. Our lawyers are experienced and willing to fight to get you the compensation you deserve.

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    1000 West Nifong Boulevard, Building 7
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    Columbia, Missouri 65203
    Phone: 573-874-4190
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