Under Illinois workers’ compensation law, you are allowed your choice of up to two doctors when getting medical help for a work-related injury. However, also under Illinois law, your employer could potentially restrict your choices to within a specific network of physicians. If your employer has a preferred provider program (PPP), you could find yourself lacking the options you would have had otherwise.
Cost of Opting Out
If you decide to opt out of your employer’s preferred provider list, you do so at a fairly significant cost. First, you must do so in writing, and secondly, opting out counts as one of your two choices of doctors. In essence, it robs you of one of your choices.
There are situations in which you can get care from a doctor outside the network and still have it covered by workers’ comp, even if you don’t opt out of the network. These are fairly specific situations, and they include:
- Getting emergency care immediately after an accident at work-related
- Any medical care you need before the injury is reported to your employer’s
Under these two circumstances, your medical care can be covered by workers’ compensation, even if the doctor wasn’t part of your employer’s network of healthcare providers.
Do Your Research
When you have the opportunity to do some research beforehand, do so. Look into the doctors in your employer’s network and see if you can trust them. It may be that your employer has selected doctors who are highly competent and will provide you the best care possible. If that’s the case, then there is no harm going within the network.
However, there is a chance that your employer has selected their network based solely on who will cost them the least and declare you able to work as soon as possible, even if that turns out to be sooner than is best for you. In that case, it may be worth losing one covered doctor in order to get the care you deserve.
Trusted Doctors, Specialists, and Referrals
If you have a doctor outside the network whom you trust completely, you can likely opt out of your employer’s PPP and visit him or her. The main purpose of having two choices of doctors is to enable you to get a second professional opinion, so if you absolutely trust your doctor, that extra choice will be less likely to be necessary.
Also, any healthcare providers your first doctor refers you to will be covered as well. In a way, they are connected to your one choice and will thus be covered as part of the chain of referrals from them. This is valuable if your primary physician refers you to a specialist to provide advanced medical care.
When deciding whether to opt out of your employer’s PPP, you may need legal assistance to make sure your rights are respected. In some cases, your employer or their insurance company may try to limit your choice of doctors or avoid paying for care outside the network. If you run into those obstacles, contact the workers’ compensation lawyers at Hart & David for the representation you need.