Your Rights Regarding Workers’ Compensation Medical Evaluations

Workers Compensation Medical Evaluations

When an employee is injured in a work-related accident and files a claim for workers’ compensation benefits, the employer, or sometimes the employer’s insurance carrier, will inform the employee in writing of the insurance carrier’s medical provider network. The employee will select a primary treating physician from the network. This physician is the first to examine the employee’s injuries, and is responsible for referring the employee to specialists, surgeons, physical therapists, and for additional tests, if need be. In the referral process, a primary treating physician must request permission from the insurance carrier for the employee to receive additional treatment, such as MRIs, surgery, therapy, or additional testing. This may seem like an uninteresting procedural detail, but it has important practical ramifications for the injured employee. Under the workers’ compensation system, the injured employee cannot refer him or herself to specialists, surgeons, or physical therapists; the referral must be made by the employee’s primary treating physician with the permission of the employer’s insurance carrier. Although the injured employee may not initiate referrals, the employee still retains the right to choose his or her own primary treating physician. So, importantly, if your employer directs you to see a certain physician – at an urgent care clinic, for example – after reporting a work-related injury, you are not required to see that physician; you have the right to see a physician of your choosing.

Procedure For Selecting A Primary Care Workers Compensation Physician Of Your Choosing

In terms of procedure, exercising the right to choose one’s own primary care physician involves a formal transfer of care. To begin the process, notify an adjuster at your employer’s insurance carrier of your intent to see a different primary care physician than the one you were initially directed to see. Second, ask the adjuster a list (or website) containing the various primary care physicians available in your area through the insurance carrier’s medical provider network. Third, research the doctors on the list to find one with a good reputation, significant experience, and positive reviews from current or previous patients. Fourth, select a doctor. Then, call the physician to see if they take on workers’ compensation patients and will agree to be your primary care physician. Finally, call your adjuster to inform them of the doctor who will serve as your primary care physician. As long as the doctor is on the insurance carrier’s medical provider network, the adjuster cannot legally deny your transfer of care.

What To Do If You Have Been Injured In A Work-Related Accident In California

If you have been injured in a work-related accident in the state of California, contact an experienced California workers’ compensation attorney. The workers’ compensation system can be complex to navigate, and a skilled attorney will listen to the specifics of your work-related accidents, explain your legal rights, and work to obtain the maximum compensation you are entitled to for your injuries.