Workers’ Comp – Do I Get to Choose My Own Doctor?

Put simply, the purpose of workers’ compensation is to help cover the expenses incurred by your injury, including doctor visits and medical treatments. There are laws governing your choice of doctors, however, so knowing what those laws are will help you avoid having to pay for massive medical bills.

Two Doctors

Under the Illinois Workers’ Compensation Act, your employer must cover the costs of up to two doctors of your choice, but only if the following qualifications are met:

  • The treatment was medically necessary
  • They treated an injury or disease that resulted from your work

This is the very bare-bones minimum, however. If it becomes apparent that you need specialized help, you may be able to petition for an extra doctor, though this is only viable under certain circumstances.

Chains of Referrals

In addition to the two doctors you choose, workers’ comp will also cover the costs from physicians your doctors refer you to. This results in chains of referrals. If, for example, you suffer traumatic injury to the face while on the job, your primary physician may refer you to a maxillofacial surgeon to repair the damage. Since this is a referral from one of your chosen doctors, your employer-or rather, their insurance company-will be expected to cover the cost.

Simply put, your choice of doctors can be defined as your right to two chains of referrals. Again, the treatments must be considered medically necessary for injuries received on the job. Also, if a physician is not a direct referral from one of your primary choices or other doctors along that chain, the expenses you incur while visiting them will not be covered.

One Catch

Now, there is one catch to your choice of doctors. A law passed a few years ago can actually limit your choice of doctors. Your employer is allowed to form a list of preferred providers for you to choose from in order to get certain expense cuts. If your employer has a preferred provider network, you’ll still be able to choose two doctors, but only as long as you choose them from that list.

There is a way out of this, however, but it has a penalty. If you opt out of your employer’s preferred provider list, it counts as one of your choices, leaving you with the choice of only one doctor (and chain of referrals) rather than two.

Certain circumstances may allow you to get access to more than one doctor of your choice outside the network. If you need specialized care that is not available within your employer’s preferred provider program, or if the treatment you receive from within the network is inadequate, you could get an exception.

Your Rights

Ensuring that your needs are met and that your rights are protected will often require legal assistance. Your employer-and their insurance company-will likely try to minimize the costs they’ll have to cover, so you need someone on your side. Hart & David provides workers’ compensation lawyers who can help you navigate the process successfully.

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