If you do not pre-designate a doctor to help you after a workplace injury in California, you must go to the doctor chosen by your employer’s workers’ compensation insurance company.
If you are worried that the doctor may be biased in favor of the insurance company, you are not alone. This is why you should consider designating a doctor you trust to serve you ahead of time.
You can also take steps to document an appointment with a doctor who you think is biased against you. It is recommended that you share this information with an experienced Bakersfield workers’ compensation lawyer.
Are Workers’ Compensation Doctors Honest?
While some workers’ compensation insurance firms choose fair doctors, others may not. Insurance companies want to pay out the least amount of compensation possible, so they search for physicians who they believe will reach conclusions that will help them achieve that goal.
Insurers may stop working with a doctor if he or she comes to conclusions that appear to benefit employees. Because doctors are aware of this, it may create an incentive for them to make choices that benefit the insurance company. They may avoid performing costly tests such as MRIs and CT scans, making it more difficult to properly assess a patient’s health.
What to Do in an Appointment with a Doctor Selected by the Insurance Company
Because physicians selected by workers’ compensation insurers may be biased against you, there are a few things you should keep in mind before and during meetings with these doctors:
- Act as if they are always keeping an eye on you. They might begin observing you as soon as you get out of your car and enter the building. Any sign of an illness is being sought after.
- Bring a companion along. In order for them to take notes and act as a witness in the event that any part of the test is disputed later, ask a friend or family member to accompany you to your appointment.
- Make a note of the meeting. Keep a journal where you can record the things that happened during your evaluation, the doctor’s comments, and how long it took.
- Be courteous. Do not be abrupt or rude to the doctor so that they can draw a bad conclusion about you.
If you subsequently find yourself in a dispute with the insurance company, having independent documentation about the examination can be helpful.
Can I Switch Doctors?
If the workers’ compensation doctor’s prognosis or evaluation leaves you unsatisfied, you can still change doctors even if you haven’t already. However, this procedure might take longer and postpone reimbursement.
If your desire for a second opinion is granted, you will be referred to a different doctor in your employer’s network. Once 30 days have passed since the date of your injury, you are free to select your own specialist if you are still unsatisfied.
However, switching physicians might not go as expected. There will be more proof against you if your new doctor concurs with the first or second doctor you saw. You might need less therapy than what the first doctor recommended, according to the second, third, or fourth doctor.
why injured workers cease seeking medical care
1. Employees’ compensation stops covering medical benefits – Many injured employees are unable to pay for care when workers’ compensation stops covering medical expenses.
When a doctor declares an injured worker to be at maximum medical improvement, or MMI, insurance administrators and nurse case managers frequently inform the injured worker that their case has been “closed.” This frequently goes along with a check for lifelong disability, which many employees mistakenly interpret as a settlement that ends their case.
In this circumstance, it is understandable why a hurt worker might believe that their case is over and decide against seeing a doctor. After all, they have been informed by a representative of authority that their case has been resolved, and they have been given payment for lifelong disability.
2. Poor or nonexistent health insurance – If a worker’s workers’ compensation claim is rejected, the worker can still pursue medical care with the help of their health insurance. Whether it’s their insurance or their spouse’s insurance, some workers do just that. That move may be beneficial. But that isn’t an option if you don’t have health insurance because it’s not provided or because you can’t pay it.
3. Unable to take time off of work to visit the doctor – Medical offices frequently remain open when injured employees are at work. The time constraint can be made even worse by commuting to work.
Readers from the insurance and managerial sides might ask, “What about FMLA?” An injured worker might be able to take time off for medical treatment under the FMLA. However, some workers might not be conscious of their FMLA rights. It can be challenging for some workers, especially those who don’t have a strong relationship with a doctor, to complete the paperwork that employers typically require for FMLA.
After hours, patients can receive assistance at urgent care facilities and ERs. However, the insurance business will likely label you as a drug seeker if you go to the ER complaining of pain.
4.Worker is estranged from treating physicians – Some workers choose not to seek medical attention when they are ill or injured because they don’t like or trust their physician. I’ll be the first to acknowledge that there are some injured workers who are irrational. But some medical professionals exhibit poor patient care. With nurse case managers who work for insurers or employers, some physicians have an overly cozy relationship. Even a reasonable and approachable injured worker may feel that seeing that specialist is pointless if either of those two conditions is true.
Some medical professionals are open to using cutting-edge pain relief methods like prolotherapy or stem cell treatment. These techniques aren’t commonly used because they are still fairly new. Since unconventional approaches to treating pain aren’t frequently used, insurers and claims managers can easily reject those unconventional approaches.