If you have suffered an injury while at work you will need to visit a workers comp doctor. So how to deal with workers comp doctors so that you dont jeopardize your insurance claim? Let’s understand the dos and donts.
If you are injured while working in your organization, you need to follow specific guidelines to get worker compensation benefits. Your first and foremost duty will be to report your injury to the organization so that your employer can contact the insurance provider.
Simultaneously you need to reach Worker’s compensation doctors to receive the appropriate and required medical care. So, how to deal with workers comp doctors?
You should clearly describe the incident about how you were injured in the workplace. Moreover, you should hide any treatment or surgery which you had undergone earlier to your worker compensation doctor.
These doctors are experts, and if they find you lying, cheating, or trying to hide something, then their report is enough to reject your compensation claim. Below, we discuss more about dealing with worker’s compensation doctors.
What Do Workers Comp Doctors Do?
The workers comp doctors are physicians who provide you needed medical care when you are injured in your workplace. These doctors have also done specialization in numerous fields like other doctors.
You can find doctors with expertise in multiple areas of physiology in your organization. This allows receiving quality medical care and getting disability benefits from your employer.
The workers comp doctors will examine you thoroughly the injured worker and may ask about their medical history. They will then access your injury and determine its severity and talk about any treatment that you may need in the future.
They provide a report which documents numerous things like the severity of the injury, your medical history, when you can be back to your work life, or whether you have a permanent disability. These reports play a significant role in getting benefits from an insurance provider.
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Who Chooses My Treating Doctor?
The rules and regulations for selecting the treating doctor vary from one state to another. In some states like California, you can appoint a doctor in advance to treat your work-related injuries and inform the employer about it by ging a written notice.
In other states, you are restricted in choosing a doctor from a list of pre-approved doctors. Moreover, there are also some states in which the employer chooses a worker’s compensation doctor so that he can treat you when you are injured or have an accident while working in your organization.
Changing Your Company Doctor
If you reside in a state where your employer or company will choose the Worker’s compensation doctor, then you may sometimes find that you are not receiving adequate medical care.
Some companies appoint Worker’s compensation doctors who provide good medical care. But there are other companies where the appointed doctors try to tone down the severity of your conditions to reduce the insurance expenses.
For instance, the doctor may deny surgery to save the insurers money or recommend getting back to work quickly, even if the injury takes a long to heal.
So, if you are dissatisfied with the treatment or recommendation of the Worker’s compensation doctor who your employer appoints, then you can think of changing doctor. You can change the doctor only once while claiming Worker’s compensation benefits.
How Can I Choose A treating Doctor For Your Workers Compensation?
If you reside in a state that allows you to choose the doctor for your Worker’s compensation, you should benefit from this opportunity. However, you need to focus on a few things, which I am describing below.
#1. The Doctor Should Accept Worker’s Compensation Insurance
The doctor you need to choose after treating your injury should accept the Worker’s compensation for paying bills. Many doctors don’t accept the Worker’s compensation because the paperwork may require time. So the patients delay in paying medical bills.
#2. The Doctor Should Have Knowledge Regarding Rules Of Worker’s Compensation
The doctor you choose for treatment after getting injured in your workplace should accept Worker’s compensation insurance and have good knowledge regarding documentation of Worker’s compensation. I will help you ensure that he will fill out the medical documentation appropriately and that the insurance company will accept your comp claim.
#3. The Doctor Should Have Experience With Your Type Of Injury
You should remember that the doctor you choose for getting Worker’s compensation benefits should have experience with your type of injury. For instance, if you have an aback problem and go to a neurologist, it is of no use. The doctor should have skills in that particular field and years of experience handling your case properly.
#4.Availability Of Appointments
No one wants to wait for a few days or months for treatment after getting injured. The doctor you need to choose for treatment should be available for appointments. It is because delay in treatment can make your health condition worse. You will even get Worker’s compensation late for paying medical bills.
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Do I Need To Go To a Worker’s Comp Doctor Immediately After Workplace Injury?
Yes, you need to go immediately after getting injured in your work organization. If you go soon, then the doctor can check your injuries and do the treatment immediately. It will even help you in getting Worker’s compensation.
Sometimes you feel well after getting injured. But don’t delay in visiting the doctor because some symptoms may appear later and can make your health condition worse.
What Is An Independent Medical Examination IME?
It is estimated that the payout of Worker’s compensation in 2017 was $62 billion. So, the insurance companies started asking for an additional medical exam to approve your claim. In this way, the insurance companies can keep payouts low.
You have to go through an independent medical exam to get benefits from the insurance provider. Sometimes the insurance company chooses the doctor who will do your independent medical exam.
The doctor who usually does the independent medical exam is an expert in treating work-related injuries and accidents. He will access your injuries and decide whether you need the medical treatment as prescribed by the Worker’s comp doctor.
It is also another way to check when you can get back to your work life or if you are disabled permanently.
This exam will have a significant effect on your Worker’s compensation. So, you should be honest while speaking to the doctor who does Independent medical exams. You should never exaggerate your symptoms nor say any lie to get disability benefits from your employer.
If the doctor finds that you are lying or exaggerating, you will provide a medical report accordingly, which can be enough to discard your claim.
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What To Expect During An IME?
The insurance companies usually request for Independent medical examination when it doesn’t agree with the decision made by the doctor. They mainly ask IME when your medical report describes permanent disability or if you need long-term treatment or surgery for a work-related injury or accident.
The insurance wants to answer some questions based on the medical report sent by the doctor who has treated you. Some questions are also similar to those you have already responded to by your treated doctor.
So the essential thing your answers need to have consistency while answering the questions to the doctor who does your independent medical exam. If they vary, then his reports can be a chance for the insurance provider to deny your claim.
I am listing below some questions generally asked by an IME doctor.
- When do your symptoms start?
- What type of treatment did you receive from the doctor who did your treatment?
- What kind of treatments are you receiving currently?
- Your limitations in doing daily work because of injury or accident in the workplace
- Your limitations in work life because of injury in the workplace.
What Should You Don’t Do With Your Workers Compensation Doctor?
#1. Overdescribing Your Symptoms
You will always want to get Worker’s compensation if you are injured or have an accident in your place. So you will describe the symptoms as severely as possible.
But if you over-describe the symptoms, your Worker’s compensation doctor can easily detect it as he is an expert. You will do various tests like scanning or ultrasound to clarify the severity.
If he finds that you are exaggerating, then that may be the reason for the denying your claim by the insurance company.
#2.Lying About Your Symptoms
Your Worker’s compensation doctor can quickly determine if you are over describing the symptoms. Similarly, if you lie about the symptoms, you can easily get caught because these doctors have many years of experience.
For instance, if you say lie regarding your hindrance like you cannot bend or cannot walk because of injury, but in reality, you can walk or bend, then the doctor can detect you by doing several tests like an ultrasound or X-ray.
If he finds you are lying about the symptoms, he will write the medical report accordingly, which may be why the insurance company can reject your claim.
So I will always advise you to be honest with your doctor. Describe the real symptoms but don’t over-describe or lie to your doctor to get compensation benefits from your employer.
#3.Saying Adverse Things About Your Boss
You may feel dissatisfied or get angry with your employer if you are injured or have an accident in your working organization. It is primarily when the company cannot provide you safety things during working, or the conditions you are working in are not safe.
But I will advise you not to speak any negative things regarding your boss during your medical examination.
If you complain about your boss, then the doctor will write those things on the medical document, which will finally be reported to your boss and insurance provider and may put you in a problem. You may have to leave your job or don’t get any compensation benefits for this to complain.
#4. Becoming Rude
You should be very polite to the doctor treating you after you are injured or have an accident in your working organization.
I know the doctor will try to find your medical history, which is quite hard to describe. He may ask several questions and find inconsistencies in them. But you should not treat the doctor like your enemy, especially when the insurance company hires him.
If you behave rudely, then the doctor may not help you, which may be expressed in a medical document that may be the reason for disapproving your claim.
Again, if you behave weirdly, the doctor may think that you are hiding some important things regarding your health, putting you in a problem. So, always keep your anger in control, especially during physical examinations.
#5. Arriving Late Or Not Attending Your IME
If you arrive late or avoid attending an independent medical examination, it will negatively affect your claim. The Worker’s compensation doctor will think that you don’t have any interest in IME even if you have a valid reason for getting late or not attending IME.
The doctor will report to the insurance company, and the company will disapprove of your claim.
So I will advise you to verify the time and date of your Independent medical exam. Again you should leave your home much early on the day of your IME, especially if you live in a city where there is heavy traffic. Try to reach out on time to affect your claim positively.
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#6. Acting In Contrast To Your Injuries
Your action and way of expression matter a lot in the IME exam. For instance, if your ankle is injured and you wear high heels on IME, the doctor will understand that you exaggerate your pain. He will write the medical report accordingly, which can have a negative effect on your claim.
Similarly, if you walk perfectly till the parking and then suddenly start limping while getting inside for the IME exam, then it is noticed by staff members in the office. They will inform your doctor. He will prepare the medical reports accordingly and send them to the insurance company that can deny your claim.
If you can walk only through crutches, then wear them during your IME so that the doctor can understand that you are using this device for your comfort. Again if you have severe ankle pain, then you should not wera them in your IME.
You should be honest while attending IME. Simultaneously your action should also speak about your IME.
#7. Omitting Details About The Accident
You will always want to get the Worker’s compensation if you are injured r have an accident while working in your organization. The doctor will ask you to describe the incident that has injured you. You need to explain all the details of the incident to your doctor.
If you miss anything, then the Worker’s compensation doctor can easily find it out because he is an expert in finding inconsistency. It shows you are not completely honest. He will make the medical report accordingly and submit it to the insurance company. The company may deny your claim for this reason.
#8. Leaving Out Past Injuries
When you go for IME, then the doctor will ask you about your medical history. If you try to hide some past injuries or any surgery from the doctor, it can negatively affect your claim.
For instance, if you hide about knee surgery and are injured on your knees, the doctor can quickly determine the surgery by seeing the scar. Again various tests and ultrasounds can detect whether you had surgery before.
So you should say almost everything in detail regarding your past medical records or any surgery which you had done earlier. If you will not say and the doctor finds it out through diagnostic imaging or by seeing scars, then he will include all those things in the medical report and for which the insurance company can deny your claim.
Frequently Answered Questions
#1. What is the longest you can be on Worker’s compensation?
If you are permanently disabled, there s no fixed time limit up to which you will receive Worker’s compensation.
#2. Can you sue a worker’s compensation doctor for malpractice in California?
No, you cannot sue a worker’s compensation doctor in California if you don’t like his medical documentation or treatment. However, you can sue if he causes harm to you by prescribing inappropriate treatment or medicines.
#3. Can I choose my own doctor for workers’ compensation in Texas?
Yes, you can select a worker’s compensation doctor in Texas. But you have only ten days to choose your Worker’s compensation doctor; otherwise, the doctor appointed by your company will treat you by law.
A Few Final Words
You may get injured or have an accident while working in your organization. The best thing you can do is inform your employer immediately and then go to the Worker’s compensation doctor for treatment.
Try to be honest and disclose all the medical conditions to the doctor. Again answer all the questions truthfully so that he can treat adequately. It will even benefit you in getting Worker’s compensation from an insurance company.
Thank you for reading this article, and hope we have covered everything related to Worker’s compensation doctors.