What You Need to Know About Workers’ Comp Doctors to Get the Care You Need
Workers hurt on the job can suffer serious injuries like traumatic brain injury, spinal injuries, paralysis, and burns, or develop an occupational disease such as cancer. They may need long-term and expensive medical care. The quality of medical care can significantly affect the employee’s recovery from his injuries and his quality of life. In some instances, it could mean the difference between life and death. So, of course, employees would prefer to pick their own doctors to ensure they receive the best medical care possible.
Under New Jersey’s workers’ compensation laws, an employer has the right to pick the doctor to treat an injured worker. However, a worker can choose his own doctor under two exceptions:
- When his employer unreasonably refuses to provide medical treatment
- When the employee needs emergency medical attention
These exceptions only apply in limited situations, so many employees must be treated by doctors chosen by their employers or their workers’ compensation insurance company. Unfortunately, this can result in workers not receiving the quality medical care they need and are entitled to.
Competency Problems of Employer-Selected Doctors
Doctors on an employer list are paid by the employer or its workers’ compensation insurance company. This can cause these doctors to have serious conflicts of interest when treating injured workers that can jeopardize the quality of care the person receives. Issues workers should be concerned about include:
- These doctors are financially motivated to work for insurance companies to supplement their private practice income or when they retire, and this can influence their medical decisions.
- Doctors with certifications in surgery, orthopedics, and other specialties are often not on employer-approved lists. These could be precisely the type of doctor an employee really needs to see.
- Because the doctor is counting on a paycheck from the employer’s insurance company, he may be reluctant to disagree with the insurance adjuster for fear he will be removed from the approved list of workers’ comp doctors.
- Often these doctors do not keep up with medical literature, pursue continuing education, or keep up on the latest research that could provide newer and more effective treatments for the worker’s medical condition.
- These doctors know that the insurance company wants to keep the medical costs down and may not recommend necessary diagnostic tests like MRIs and CT scans or therapeutic services like physical therapy because they are too expensive.
Other Potential Conflicts of Interest You Should Be Concerned About
Doctors hired by insurance companies can have other conflicts of interest that could affect a worker’s medical care or end up costing him money. Some of these potential problems include:
- Ownership of medical facility. A doctor may own or have a financial interest in a medical facility he refers a worker to. This could result in him ordering unnecessary tests or treatments that the insurance company could refuse to pay for—leaving the employee responsible for the bill. Employees need to be certain the test or treatment has been pre-approved by the workers’ comp insurance company to avoid this problem.
- Selling prescriptions. Some states allow doctors to not only prescribe medications, but also to sell them to patients. Unfortunately, some physicians inflate the cost of their prescriptions, leaving workers with expensive bills if the insurance company finds them unnecessary or unjustified.
What You Can Do If You Don’t Like Your Doctor
If you have concerns about the treatment you are receiving from the doctor selected by your employer or the workers’ compensation insurance company, you may be want to switch doctors. This is sadly a common concern for injured workers in workers’ compensation cases. Here is what you need to know about changing doctors:
- You would need to show that you are not receiving reasonable and necessary treatment to cure or relieve your injuries or to restore your functional abilities.
- You would need to file a Motion for Medical and/or Temporary Disability Benefits. A hearing will be held on your motion with a judge quickly—often within 30 days of it being filed.
- You should retain an experienced workers’ compensation attorney to file and argue the motion for you. The insurance company will retain their own attorney, and you would be at a serious disadvantage if you try to represent yourself.
Were you injured on the job and concerned about the quality of the medical care you are receiving? I have been helping workers like you for over 20 years. Check out my Testimonials and then call me at 877-360-0183 to schedule a free consultation to learn how I can assist you.