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If I Have a Work Injury, Do I Have to Treat with the Company Doctor?

Daniel Klosowski
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As mentioned in a previous blog, an injured worker does have the right to treat with their own physician. Just because a person is injured at work does not mean they have to treat with a doctor that is chosen by their employer or their employer’s workers’ compensation insurance carrier. The law in Illinois regarding an injured employee’s choice of physician has become more complicated in recent years.

The old law in Illinois regarding choice of doctor was fairly simple. The rule was colloquially referred to as the “two-choice rule”. Basically, this meant that an injured worker could treat with two separate chains of doctors and any referrals from that doctor. For example, an injured worker could visit their regular primary care physician and receive a referral to an orthopedic specialist. That visit and referral would be part of one choice. If the injured worker was not satisfied with their care, they could visit a completely new doctor of their choosing and any referrals from that doctor as their second choice.

Changes in the law were passed in June 2011. However, it was not until March 2013 that these changes began to take effect. The changes allowed workers’ compensation insurance carriers to establish Preferred Provider Programs (PPP’s). These programs limit the injured employee’s independence when it comes to their choice of doctor. A PPP is a network of medical providers that has been approved to provide medical care for workers’ compensation injuries for a particular employer or insurance company. An injured worker that works for an employer with a PPP has two choices of medical providers from within the employer’s network. If after using the two choices within the PPP, the injured employee wants to treat with a doctor outside of the PPP, the Illinois Workers’ Compensation Commission must determine that the second choice of physician has not provided adequate care.

So, like above, the employee can treat with two separate medical providers and any referrals from that provider. However, unlike above, these two medical providers are both within the PPP. The employee does not have the initial option to choose to treat with their own choice of physician and have a second choice of provider remaining. Instead, if the injured employee wants to treat with their own physician and that physician is not part of the PPP for their employer, they have to opt out of the PPP in writing, and that counts as their first choice. Their own physician that is outside of the PPP now becomes their second choice of provider, even if they have received no medical treatment before opting out!

Given the delay in this law being fully implemented in Illinois, cases that are currently open can fall under the old law or the new law. The date of accident becomes very important to determine which law the case falls under. If you find yourself in a position where you are interested in changing your doctor for a work injury, it may be valuable to contact an experienced workers’ compensation attorney who can determine whether a choice remains available. If an injured worker treats with a doctor that falls outside their available number of choices, the workers’ compensation insurance carrier’s liability for paying medical bills from that provider ends.

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