Changing Doctors in Your Workers’ Compensation Case

changing doctors work

Changing Doctors in Your Workers’ Compensation Case

When you’re recovering from a work injury, it is important to have a good relationship with your treating doctor.

 

Your doctor will not only provide important medical treatment but will also refer you to specialists, set your work restrictions, and decide whether you have a permanent disability. If your treating doctor does not support your workers’ comp claim, the insurance company will typically deny benefits.

If you are unhappy with your treating doctor, you may be able to change physicians. Make sure you understand the rules and procedures in your state before changing doctors. If you fail to follow the correct process, the insurance company may refuse to pay your medical bills.

 

Who Chooses My Initial Workers’ Comp Doctor?

In an emergency, you have the right to seek treatment from any doctor or hospital. However, for non-emergency treatment, you will need to follow your state’s workers’ compensation rules. In many states, your employer or its insurance company has the right to select the treating doctor who will provide your ongoing medical care. In other states, you can pick your own doctor from the very beginning. And, in still other states, the rules are more complicated—for example, you might need to select a doctor from an approved panel or network from your employer. 

 

Can I Switch Workers’ Compensation Doctors?

Sometimes, you may feel that your occupational doctor is more concerned about your employer’s financial well being than your full recovery. If your condition is not improving or you are dissatisfied with the doctor’s medical care, you may be able to change doctors. Every state’s workers’ comp system is different. In most states, you can change doctors at least once. However, depending on where you live, there may be other limitations on your ability to change medical providers.

 

Insurance Company Selects the New Doctor

Some states allow the insurance company to control all medical treatment in a workers’ comp case. In these states—such as Florida, New Jersey, North Carolina, and Virginia—you may ask for a new doctor, but the insurance company will typically select the new doctor for you. If the insurance company denies your request, you can usually appeal the decision to your state’s workers’ compensation agency. However, appeals regarding medical treatment can be tricky, so you may want to consider hiring an experienced workers’ comp lawyer for help.

 

Mandatory Waiting Period

Other states, including Pennsylvania and Michigan, allow workers to switch physicians after a waiting period. The length of the waiting period varies from state to state (ranging from one appointment to 90 days). However, after that time period, you may treat with a doctor of your own choosing. You should not start treating with a new doctor until you give the insurance company adequate notice. Otherwise, you may be billed for treatment received before you gave notice.

 

Limit on Number of Changes

Another group of states allows you to change physicians but limits the number of times you can do so. For example, in Illinois, you can change doctors twice without the insurance company’s permission. (After your second change, you must get either the insurance company’s approval or a court order before switching doctors.) Georgia allows a one-time change of physician. If you’ve used up your automatic changes and are still unhappy with your treatment, a workers’ compensation lawyer can help you request approval for an additional charge.

 

Authorized Medical Providers

Some states, including New York and Washington, allow workers to choose their treating doctors. However, they have a directory of medical providers who are authorized by the state to treat injured workers. If you treat with an unauthorized doctor, the insurance company may not pay the doctor’s bills. These states typically have an online directory of authorized doctors. While you may be able to change physicians, you must treat with an authorized provider.

 

What If My Employer Has a Managed Care Organizations or Provider Network?

A managed care organization (MCO) is a network of physicians that treat injured workers. MCO’s are an increasingly popular way to reduce workers’ comp expenses for employers. If your employer provides treatment through an MCO or provider network, you typically may change physicians, but your new doctor must also be within the network.

 

Can I Get a Second Medical Opinion?

If you’re not able to change doctors, you may still be able to get a second opinion in some states. In general, a second opinion doctor does not provide ongoing treatment. Instead, the doctor will perform a one-time examination, review your medical records, and give recommendations on your treatment, work restrictions, and limitations. The insurance company will consider the second opinion report and findings when assessing your workers’ comp claim. A second opinion can also be used as evidence at a workers’ compensation hearing if your benefits are denied.

Second opinions are usually available when the insurance company has control over your medical care and selects your treating doctor. The process for requesting a second opinion varies from state to state. Typically, if your claim has been denied, the insurance company will not pay for a second opinion. Instead, your workers’ compensation lawyer may send you to an independent medical examination with a doctor of his or her choosing. 

 

Tips on Finding a New Workers’ Comp Doctor

When you choose a new doctor, you should consider a series of factors, including:

  • whether the doctor has experience treating your medical condition
  • how familiar the doctor is with workers’ compensation claims
  • whether the doctor is willing to testify in support of your claim, and
  • whether the doctor is professional and would make a good witness.

It is important that you trust the provider and feel comfortable with his or her treatment recommendations. If you need help finding a doctor, a workers’ compensation lawyer may be able to recommend a physician, especially if you need to select one from your employer’s network. Workers’ comp lawyers are often familiar with occupational doctors and can tell you which ones are likely to be open-minded and fair.

 

Original article: http://www.nolo.com/legal-encyclopedia/changing-doctors-workers-compensation-case.html

 


 

Call 216-342-9199 or fill out the form below to schedule a no-cost to you consultation for any problems or injuries that you may be suffering due to your work related injuries.

Upon completing your initial consultation your care options will be discussed in detail so you can make an informed decision regarding your care.

It is the goal of our office to provide you (the injured worker) with the care and knowledge needed to make responsible decisions regarding your health and wellness.

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whiplash pain

What is Whiplash?

What Is Whiplash?

Whiplash occurs when the neck and head are suddenly forced backward and then forward, putting the cervical spine through lightning-quick motions and extreme stresses.

Most cases of whiplash are caused by car accidents where the person has been rear-ended. Other potential whiplash causes, while comparatively rare, can include assault, bungee jumping, rollercoaster, football, falls while skiing or during equestrian events, and other high-impact activities where extreme acceleration-deceleration forces might be applied to the cervical spine.

Whiplash is medically known as cervical acceleration-deceleration (CAD) syndrome.

 

Whiplash Symptoms Can Be Extensive

The most common symptom of whiplash is neck pain, which can range anywhere from mild to pins-and-needles tingling to excruciating. Other symptoms can include neck stiffness or reduced range of motion, neck instability, shoulder and/or upper back pain, or headache. There could also be tingling, weakness, or numbness that radiates into the shoulder and/or down the arm.

Whiplash symptoms can be numerous, complicated, long-lasting, and hard to diagnose, which is why they are commonly known as whiplash-associated disorders. Concurrent injuries may also be symptomatic, such as a stinger, concussion, radiculopathy (pinched nerve with radiating pain into the arm), or shoulder injury.

If a whiplash injury causes a person to have reduced physical or mental abilities—even if they are just temporary—it can result in increased social isolation.

 

The Biomechanics of Whiplash

The process of a whiplash injury sustained in a car accident can vary depending on many factors, including the angle of the collision.

Usually, the collision happens from behind, resulting in a whiplash injury that can be considered to occur in five general phases:

  • Car gets hit from behind, which causes the seat to push against the back. The spine then gets loaded with forces that compress the cervical spine upward against the head.
  • The torso (in contact with the seat) continues to accelerate forward but the head (not in contact with the seat yet) does not. As a result, the cervical spine’s natural C-shape (lordosis curve) temporarily becomes an unnatural S-shape. The abnormal compression and shearing forces can potentially damage intervertebral discs, facet joints, and other neck structures.
  • Person’s head slams backward into the accelerating seat. Soft tissues at the front of the neck are likely to be injured here as the neck rapidly extends backward.
  • The head bounces off the seat and now accelerates forward.
  • The seatbelt restrains the body (likely preventing a much worse injury) and the neck rapidly flexes as the head whips forward. Soft tissues at the back of the neck are likely to be injured here.

While the severity of the car crash usually correlates to the severity of the whiplash injury, there are exceptions.

Sometimes a sturdy car does not crunch up and thus shows no significant outside damage, but the forces that were not absorbed by the car exterior were instead transferred through the seat and thus caused worse whiplash. Also, whiplash injuries have been recorded in incidents where the speed at impact was less than 10 miles per hour.

 

The Course of Whiplash Pain

Most people who sustain a whiplash injury will completely recover within 3 months, but some studies show a significant number will have chronic pain or other symptoms that linger longer – sometimes for years.

Factors that increase risk for a longer whiplash recovery include:

  • Severe pain at time of injury
  • Post-traumatic stress disorder
  • Older age
  • Female gender

Whiplash symptoms may present at the time of the whiplash injury, or there could be a delay of up to 24 hours before they appear.

 

When Whiplash Is Serious

Anyone who experiences physical symptoms after a motor vehicle accident is advised to see a doctor for a checkup. However, any of the following signs require immediate medical attention:

  • Severe pain
  • Neck instability
  • Pain, tingling, numbness, and/or weakness that radiates into the shoulder, arm, and/or hand
  • Problems with balance or coordination
  • Mental health issues, such as increased irritability, depression, trouble sleeping, reduced concentration, or other drastic changes in behavior

Seeking treatment early for whiplash is recommended. Delaying treatment can reduce its effectiveness in some cases.

As seen on Spine-Health: http://www.spine-health.com/conditions/neck-pain/what-whiplash

 


 

If you or someone you know was injured in a recent car accident, we welcome you to contact us to see about your treatment options

440-342-9199


injury claim car accident

How Do Insurers Value an Injury Claim?

Here at Eastside Medical Group in Shaker Heights, we see a lot of people come through our doors who have been injured in a car accident.

Our hearts go out to these people because they are not only dealing with the pain from the auto accident injury, they are also having to work with their insurance companies for their personal injury claim to get the medical attention they need.

Recently, we came across an article* that explains some fundamentals that insurance companies use to determine the value of an injury claim. We hope it is useful to those of you who are injured.

If you are seeking medical attention due to a car accident, please give us a call here at Eastside Medical Group in Shaker Heights, and let us help you with our integrated medical services.

Here’s how insurance companies determine the value of your personal injury claim.

Figuring out how much your accident injuries are worth is a critical aspect of any personal injury claim, and it’s the part of a claim that is most difficult to determine; the amount varies depending on your very particular circumstances. Here is an overview of how insurance companies determine the value of a claim.

What an Insurance Company Must Compensate

To determine what your claim is worth, you must first know the types of damages for which you may be compensated. Usually, a person who is liable for an accident – and therefore his or her liability insurance company – must pay an injured person for:

  • medical care and related expenses
  • income lost because of the accident, because of time spent unable to work or undergoing treatment for injuries
  • permanent physical disability or disfigurement
  • loss of family, social, and educational experiences, including missed school or training, vacation or recreation, or a special event
  • emotional damages, such as stress, embarrassment, depression, or strains on family relationships – for example, the inability to take care of children, anxiety over the effects of an accident on an unborn child, or interference with sexual relations
  • damaged property.

The Insurance Company’s Damages Formula

When determining compensation, it is usually simple to add up the money spent and money lost, but there is no precise way to put a dollar figure on pain and suffering or on missed experiences and lost opportunities. That’s where an insurance company’s damages formula comes in.

At the beginning of claim negotiations, an insurance adjuster adds up the total medical expenses related to the injury. These expenses are referred to as “medical special damages” or simply “specials.” That’s the base figure the adjuster uses to figure out how much to pay the injured person for pain, suffering, and other non-monetary losses, which are called “general” damages.

When the injuries are relatively minor, the adjuster multiplies the amount of special damages by 1.5 or 2.

When the injuries are particularly painful, serious, or long-lasting, the adjuster multiplies the amount of special damages by up to 5. (The multiplier may be as great as 10 in extreme cases.)

The adjuster then adds on any income lost as a result of the injuries.

That’s all there is to the formula. However, this figure — medical specials multiplied by a number between 1.5 and 5, then added to lost income — is not a final compensation amount but only the number from which negotiations begin.

Percentage of Fault in an Injury Claim

The extent each person is at fault is the most important factor affecting how much the insurance company is likely to pay. The damages formula gives you a range of how much your injuries might be worth, but only after you figure in the question of fault do you know the actual compensation value of your claim — that is, how much an insurance company will pay you.

Determining fault for an accident is not an exact science, but in most claims, both you and the insurance adjuster will at least have a good idea whether the insured person was entirely at fault, or if you were a little at fault, or if you were a lot at fault. Whatever that rough percentage of your comparative fault might be — 10%, 50%, 75% — is the amount by which the damages formula total will be reduced to arrive at a final figure.

 
Eastside Medical Group
216-342-9199
Dr. Lauchlin McKeigan, DC
Dr. Jessica Dilley, DC
Dr. Karen Bodnar, DC
Serving patients in Shaker Heights, East Cleveland, and surrounding areas

*Source: http://www.nolo.com/legal-encyclopedia/how-do-insurers-value-injury-29976.html


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