You were injured at work, and nothing like that has ever happened to you before – so you didn’t realize exactly how important your choice of treating physician would eventually be to your workers’ compensation claim.
You went with your employer’s recommended physician, and that turned out to be a big mistake. Is there any hope of making a switch? Here’s what you need to know:
It only takes two visits to become your primary treating physician
Once you’ve seen a doctor twice for your workplace injury, that doctor becomes your “primary treating physician” for workers’ comp purposes. That means that they control the direction of your care and even which specialists you see. They also write the reports that ultimately determine whether your benefits are approved or denied and how long they will continue.
If you don’t mesh well with a physician right off the bat (or you get the feeling that they’re more concerned about the company’s situation than yours), it’s best not to make a second visit.
You have one chance to make a change within the first 60 days
If it’s already too late, you can still make the jump to a new physician within the first 60 days of your initial treatment without anybody’s prior approval – but choose carefully: This is a one-time opportunity to get under better care.
After 60 days, you need the insurer’s approval or the consent of a judge
Once you’ve exceeded the 60-day mark you may be stuck unless you can convince either the insurance company or a workers’ comp judge to allow you to switch – and they’ll only do so if you can offer them a reasonable basis for the change. That might include a breakdown in the doctor-patient relationship or a failure to improve, but you could also be denied if the court thinks that’s just a pretext to get a more favorable disability rating.
When your workers’ compensation claim doesn’t go as expected, it may be time to seek more experienced legal guidance to help you through.
