Medical treatment is a fundamental workers' compensation benefit, but navigating the system's rules about which doctors you can see and what treatment you can receive creates frustration for many injured workers. Understanding your rights regarding medical care and physician choice helps you get proper treatment while protecting your claim.

Initial Treatment Rights

When you first suffer a workplace injury, emergency treatment is always permitted at the nearest appropriate medical facility regardless of any network restrictions. For non-emergency initial treatment, rules vary significantly by state. Some states allow injured workers to choose their own doctor from the start, while others require initial treatment through employer-designated physicians or managed care networks.

Know your state's rules about initial treatment to avoid complications. If your state requires use of a designated provider network, treating outside that network without proper authorization may result in bills the workers' compensation insurer refuses to pay, leaving you personally responsible.

Changing Doctors

Most states allow injured workers to change treating physicians at some point, though the process varies. Some states permit unlimited changes, others allow one change as a matter of right with additional changes requiring approval, and some limit changes more strictly. Understanding your state's change procedures helps if you're dissatisfied with your assigned physician.

Valid reasons for seeking a different doctor include communication problems, lack of specialist expertise needed for your condition, geographic inconvenience, or dissatisfaction with the treatment approach. When requesting a change, follow proper procedures rather than simply seeing a different doctor without authorization, which could jeopardize coverage for that treatment.

Second Opinions

When you disagree with your treating physician's opinions about your diagnosis, treatment recommendations, or work restrictions, seeking a second opinion may be appropriate. Most states allow second opinions, though procedures and payment responsibilities vary. Some states require insurer authorization for second opinions, while others allow them more freely.

Second opinions become particularly valuable when significant decisions like surgery are recommended or when your doctor suggests you've reached maximum medical improvement before you feel ready to return to work. A different medical perspective can confirm or challenge your primary physician's conclusions.

Independent Medical Examinations

Workers' compensation insurers often request independent medical examinations with doctors they select to evaluate disputed issues in your claim. While called independent, these examinations are paid for by the insurer and often produce opinions favorable to denying or limiting benefits. You typically must attend these examinations when properly requested.

Prepare for IMEs by understanding what issues the examiner will address. Be honest and consistent with what you've told your treating physicians. You can typically have someone accompany you to the examination, and in some states you can record the examination. Document how long the examination lasted and what the doctor did and didn't do.

Treatment Disputes

When insurers deny treatment your doctor recommends as medically necessary, dispute resolution processes exist to challenge those denials. Utilization review procedures often provide initial review of treatment denials. If utilization review upholds the denial, further appeals through the workers' compensation system may be available.

Documentation supporting medical necessity strengthens treatment disputes. Your doctor's opinions explaining why treatment is necessary and relevant medical literature supporting the treatment approach help counter insurer arguments that treatment is excessive or unnecessary.