You Can Choose to Treat with Your Own Doctor…and Your Employer Has to Pay the Bill
If you have been hurt at work, some of the first questions you might have are…Do I have to pay for my medical treatment? Do I have to treat with the company doctor? The answer to both of these questions is no.
Your employer has to pay for all your reasonable and necessary medical treatment. This includes all emergency care, surgeries, hospitalizations, physical therapy, office visits, and medication. You are not responsible for one cent!
It is very important to know that you have the right to choose the doctor with whom you want to treat. It gets even better! You also can treat with any doctor or medical provider that your choice of doctor refers you to see. There is no limit on the number of referrals.
For example, you may choose to first treat with your family physician. That doctor may refer you to a specialist who may then refer you to a physical therapist. Although you would have seen three medical providers, in Illinois, this only counts as one choice of doctors.
It gets better still! In most cases, you have the right to choose two doctors. This is known as the two choice rule. Your second choice of doctors may refer you to other medical providers just as your first choice of doctors did. Emergency room treatment, either immediately following your injury or at other times that you may need it after your injury, does not count as a choice of doctor.
There are exceptions to the two choice rule. Recently, the Illinois legislature amended the workers’ compensation law. Under the new amendment, your employer may choose to be part of a Preferred Provider Plan (PPP). Such a plan is very similar to plans you may see with your own HMO or PPO private insurance. The PPP must include doctors to treat most types of injuries. If your employer is part of a PPP, it must notify you of the plan’s existence and how you may find out which doctors participate in that plan. If your employer is part of a PPP and fails to tell you this, you are free to use the two choice rule. If your employer does notify you that it is part of a PPP plan, you do have the right to opt out of participating in that plan. If you do so, you must tell your employer that you are opting out in writing. If you do opt out, you may only choose one of your own doctors.
It is extremely important to know that you do not have to treat with a company doctor or company clinic…ever. Your employer cannot order you to treat at any specific clinic or with any specific doctor. Even if your employer is part of a PPP, you still are free to choose doctors from that plan. It is always best to choose your own doctor. Usually, you will feel a sense of trust with your own doctor that you may not always feel with the company clinic.