What happens if the company doctor won’t approve your care?

On Behalf of | Apr 4, 2022 | Workers' Compensation |

Workers’ compensation benefits protect you if you get hurt on the job or develop a medical condition because of your job functions. Workers can receive disability benefits and medical treatment for work-related medical conditions through Minnesota workers’ compensation.

Some of the rules that govern workers’ compensation confuse employees and impact their ability to connect with benefits. For example, workers sometimes don’t understand the rules about who gets to choose the medical care provider and the treatment that they receive.

If your employer has a company doctor or if they participate in a managed care plan for workers’ compensation, you generally have to let their chosen professionals provide your care. What if you don’t agree with the treatment they recommend? 

Your benefits rights depend on medical necessity

The medical professional overseeing your workers’ compensation claim is the person who decides what kind of treatment you need and when you can go back to work. You may feel like the doctor has made unreasonable or unfair decisions about your treatment and want a second opinion.

Unfortunately, in most scenarios, workers’ compensation will not cover the cost of the consultation with an outside medical professional once you have already begun treatment. Of course, the lack of coverage won’t prevent you from seeking a second opinion. You may have to cover those expenses yourself to get the documentation necessary to push for different treatment.

The one exception to this rule is when the recommended treatment involves surgery. If you disagree with the doctor’s surgical recommendation, workers’ compensation may cover a second opinion before you agree to undergo the procedure.

Paying out of pocket may be worthwhile

Many workers who wish to undergo different treatment or who disagree with the conclusion reached by a physician participating in a managed care plan will find that paying for their own consultation is a good decision.

A consultation with an outside professional may help them connect with better treatment or facilitate a successful appeal when there is a conflict regarding workers’ compensation benefits. Of course, a worker has to know their rights to assert them and get the right care for a work-related medical issue. Learning the rules that govern workers’ compensation claims and medical treatment in Minnesota will help you better handle a complex claim.

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