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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workers' compensation

Can You Sue Outside of Workers’ Compensation?

Workers’ compensation insurance may not be your only recourse for a workplace injury.

 

If you’ve been injured in the workplace, you’ve probably been told that the only compensation you can receive will come from your employer’s workers’ compensation insurance. Although this is the general rule, there are many exceptions – situations in which you may be able to sue for damages caused by your injuries.

For example:

  • If you were injured by a defective product, you might be able to bring a products liability action against the manufacturer of the product.
  • If you were injured by a toxic substance, you might be able to bring a toxic tort lawsuit against the manufacturer of that substance.
  • If you were injured because of your employer’s intentional or egregious conduct, you might be able to bring a personal injury lawsuit against your employer.
  • If your employer does not carry workers’ compensation insurance, you might be able to sue your employer in civil court or collect money from a state fund.
  • If a third party caused your injury, you might be able to bring a personal injury lawsuit against that person.

 

Although workers’ compensation can provide money and benefits to an injured worker, temporary disability, and permanent disability payments are usually quite low and don’t compensate the worker for things like pain and suffering. Workers’ compensation also does not provide punitive damages to punish an employer for poor safety controls or dangerous conditions. That’s why it’s important for injured workers to understand their rights to bring a case outside of the workers’ compensation system.

In addition to the lawsuits described in this article, you might obtain additional money from government benefits such as Social Security disability insurance (SSDI or SSI) if your injury is disabling and prevents you from working.

 

If You Were Injured by a Defective Product

When a worker is injured by a machine or piece of equipment that is defective, failed to work properly, or is inherently dangerous, the manufacturer of the machine or equipment can be held responsible for the injury if it knew of the danger and/or didn’t properly warn the business or employees of the danger. In such a situation, the manufacturer would have to compensate the worker for things like medical bills, lost wages, and pain and suffering.

Example:

Bill works in a factory that produces office products. His job is to operate a punch press that punches holes in boxes. One day, when Bill puts his hand into the press to adjust a box, the foot pedal that he uses to stop the press sticks, and the press crushes three of his fingers. His fingers are no longer usable after the accident. Bill can collect workers’ compensation from his employer, and he also has a possible products liability case against the manufacturer of the defective press.

If you have been injured by an unsafe machine or other equipment in your workplace, consider talking to an attorney about your rights. You can also file a complaint with the Department of Labor’s Occupational Health and Safety Administration if there have been unsafe conditions, in addition to filing a workers’ compensation claim. This is a particularly important step to take if your employer is still requiring you or other employees to use the equipment.

 

If You Were Injured by a Toxic Substance

Sometimes the chemicals and other substances that workers use are toxic and cause severe injuries and illnesses. These substances can include such things as asbestos, benzene, chromium compounds, silica, and radium, but any substance that harms you could possibly be the subject of a lawsuit for a “toxic tort.”

Generally speaking, there are two kinds of toxic injuries: acute injuries are apparent immediately, while latent injuries may take years to appear.

Examples of acute injuries include chemical burns and poisonings. Examples of latent injuries include cancers and lung diseases. Because of the time delay, latent injuries tend to be more difficult to prove than acute ones, but these cases are not impossible. Workers have been successful in lawsuits brought years after their exposure to the toxic substance. (In particular, workers who suffer from asbestosis or mesothelioma almost always succeed in lawsuits because the causation between exposure to asbestos and asbestosis and mesothelioma has been proven in many lawsuits).

When a worker is injured by a toxic substance, the worker can usually sue the manufacturer of the toxic substance and any manufacturers of safety equipment that proved to be ineffective in the handling of the toxic substance.
If you have been injured or sickened by a toxic substance, talk to an attorney about your legal rights. Especially if a great deal of time has passed between your exposure and your injury or illness, you will need the assistance of an expert to help you sort out the complicated issues involved. And even if the toxic injury was recent, an attorney can probably get you the best settlement for your injury.

If the toxic substance is continuing to make the workplace unsafe for your or others, consider taking the additional step of filing a complaint with the Occupational Safety and Health Administration (OSHA).

 

Originally published: https://www.nolo.com/legal-encyclopedia/workplace-injury-lawsuit-sue-30334.html


 

At Eastside Medical Group, we are Ohio BWC Certified to provide work injury care.

Call us today to discuss your work-related injury!

216-342-9199

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medical treatment work injury

Seeking Medical Treatment for a Work-Related Injury

Seeking Medical Treatment for a Work-Related Injury

Find out when, where, and how to get medical treatment in your workers’ comp case.

If you suffered an injury at work or while performing your work duties, it’s important to take the right steps when seeking medical treatment. Getting appropriate medical care is not only important for your health and recovery, but also for maximizing your workers’ compensation benefits and making sure that you’re properly compensated for your injuries.

 

When Should You Seek Treatment?

With any injury, even injuries that seem minor, you should seek treatment right away. This means seeing a doctor immediately after a work-related accident or at the first sign of any symptoms that might be due to your work duties.

Being treated soon after you’ve been injured serves two important purposes. First, early treatment makes it more likely that you’ll recover from your injuries faster. Second, the closer in time to your accident that you receive treatment, the less room it gives your employer (or its insurance company) to argue that your injuries are not work-related.

No matter what, you should resist the urge to “tough it out” or downplay the seriousness of your injuries. This can delay or impede your recovery, and it can affect the scope of treatment authorized by workers’ comp or the amount of benefits you ultimately receive.

 

Where Should You Go to Get Treatment?

If you need immediate medical attention, you should go to the nearest emergency room for treatment. For non-emergency situations, you’ll need to follow your state’s rules on the proper channels for obtaining medical care.

Some states give the employee the right to choose the doctor who will treat you for your injuries (called your “treating doctor” in workers’ comp lingo), while others give the employer that right. Still other states have more complicated rules for selecting a treating doctor.

Although doctors hired by employers (or their insurance companies) are supposed to be objective, they often have close and financially rewarding relationships with the employers that refer them cases. Because of this, it’s in your best interest to receive treatment from a doctor you know and trust.

Whenever possible, you should choose your own treating physician. Make sure to choose a doctor who is both experienced and articulate. Treating physicians are often called upon to provide written reports or even oral testimony, so it’s important that your doctor can clearly and convincingly explain the reasons behind his or her decisions regarding your care.

In any case, you should make sure that you obtain treatment through the correct avenues and from a properly licensed or credentialed doctor. Otherwise, you run the risk that your medical bills will not be covered.

 

What Role Does Your Treating Doctor Play?

The doctor who ends up treating you will play an essential role in your workers’ compensation case. Your treating doctor will make important decisions about your care, including:

  • whether your injuries are work-related
  • the nature and scope of the treatment you receive
  • how much time off from work you need or whether you need light duty
  • when you have reached “maximum medical improvement” (defined below), and
  • the extent to which you have any permanent disability.

These decisions will have a large impact on what treatment you receive and what benefits you are entitled to. For example, if your doctor says you’ve reached maximum medical improvement, this means that your condition has plateaued to the point where further medical treatment isn’t helpful. It also means that you’re no longer entitled to temporary disability benefits.In addition, the degree of permanent disability your doctor believes you have will help dictate

In addition, the degree of permanent disability your doctor believes you have will help dictate the amount of permanent disability benefits you receive. 

 

What Should You Tell Your Doctor?

Even with the advancement of medical technology, doctors still rely on patients to report symptoms, severity of pain, and activities that are difficult or impossible to perform. This is especially true for soft tissue injuries (injuries that don’t involve bones), which often cannot be verified through medical imaging devices such as x-rays.

Because some injuries can be more subjective in nature, it’s especially important for you to communicate with your doctor about what you’re feeling.

In doing so, you should follow these guidelines:

  • Be honest and accurate. Describe your symptoms to your doctor truthfully. Don’t exaggerate, but don’t downplay your symptoms either. An experienced doctor will know when you’re not telling the truth, and you’ll lose credibility.
  • Err on the side of inclusion. Tell your doctor about all of your symptoms, even ones that seem minor or fleeting. Your doctor is the expert, and you should let him or her decide what’s important. Besides, a symptom that seems insignificant now may develop into a serious problem weeks or months down the road.
  • Don’t speculate. If you don’t know the answer to a question your doctor asks, just say so. Never guess about what the cause of your injuries might be, and don’t say that you have fully recovered unless you’re sure that’s the case.

 

Who Pays for Your Medical Bills?

In most states, your employer is required to pay for your medical bills until a decision has been made to accept or deny your claim, at least up to a certain amount.

If your claim is approved, your employer will continue to pay for your medical bills for approved treatment.

If your claim is denied, you can pay for your own bills and seek reimbursement from the workers’ comp insurance company once the denial is overturned. Or, some doctors might agree to treat you on what’s called a “lien basis,” meaning that payment for your bills will come out of any recovery you get through workers’ comp. In the meantime, if your state has a temporary disability insurance program, you may be eligible to apply for these short-term benefits to make up for some of your out-of-pocket costs.

 

Getting Help

Workers’ compensation claims can be difficult to navigate, especially if your employer is fighting any portion of your claim. Getting the help of an experienced workers’ compensation attorney can be invaluable in making sure you’re fully compensated for your loss. 

 

Original Article: http://www.nolo.com/legal-encyclopedia/seeking-medical-treatment-work-related-injury.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 medical treatment 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 medical treatment care and knowledge needed to make responsible decisions regarding your health and wellness.

Eastside Medical Group
216-342-9199
Dr. Jane Hoashi, M.D. and M.P.H.
Dr. Lauchlin McKeigan, DC
Dr. Karen Bodnar, DC
Dr. Jessica Dilley, DC
Dr. Matthew Woodworth, DC
Serving patients in Shaker Heights, Maple Heights, East Cleveland, and surrounding areas

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workers' comp

Filing A Workers’ Comp Claim

Filing a Workers’ Compensation Claim

By Barbara Kate Repa for NOLO.com

Find out how – and where – to file for workers’ comp.

If you’ve been injured or become ill at work, you may need to file for workers’ compensation. Workers’ compensation pays for medical care, rehabilitation, and some wage replacement if you have to miss work. To get these benefits, you must file a claim and follow your state’s procedures carefully.

Filing a Claim

Get immediate medical care if your injury requires it. You must then inform your employer of your injury as soon as possible. This is a tricky part of processing a workers’ comp claim since states have wildly different limits on the number of days you have to notify your employer; in most states, the limit is one month, but the range is from a few days to two years.

In the unlikely event that your employer refuses to cooperate with you in filing a workers’ compensation claim, a call to your local workers’ compensation office will usually remedy the situation.

Typically, your employer will have claim forms for you to fill out and submit or can obtain a form quickly. It then becomes your employer’s responsibility to submit the paperwork to the proper insurance carrier. Depending on state law, you—rather than your employer—may need to file a separate claim with your state’s workers’ compensation agency. There is a time limit on this, too—often a year after injury. But your state may have a shorter limit.

If your claim is not disputed by your employer or its insurance carrier, it will be approved and an adjuster for the insurance company will typically contact you or your employer with instructions on how to submit your medical bills for payment. But be prepared; things do not always go smoothly. The employer, in an attempt to keep workers’ comp rates from skyrocketing, may fight your right to benefits. The best way you can counteract such disputes is by producing good documentation, including complete medical records, of your injury and treatment.

If your injury is not permanent and does not cause you to lose income, getting payment for your medical bills will probably be the extent of your claim; there won’t be much else for you to do. If you are temporarily unable to work because of your injury, you will also begin receiving checks to cover your wage loss—typically within a week or two after your claim is approved. Your employer will notify the insurance company to stop sending you wage-replacement checks as soon as you recover and return to work.

Ohio Workers’ Compensation Office

Ohio Bureau of Workers’ Compensation
30 W. Spring Street
Columbus, OH 43215
800-644-6292
FAX: 800-520-6446
www.ohiobwc.com


At Eastside Medical Group, we are Ohio BWC Certified to provide work injury care.

Call us today to discuss your work-related injury!

216-342-9199

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work injury

Should You Get An Attorney For Your Work Injury?

Should You Get An Attorney For Your Work Injury?

If any of the following are true with your work injury, you should retain an attorney as soon as possible:

1. Your workplace injuries are severe enough to require surgery.

2. Your workplace injuries are moderate to severe. If you and your doctor believe your health won’t return to the condition it was prior to your injury, you may be entitled to a “permanent partial disability” award.

3. You believe you are no longer able to work on a regular basis in any job.

4. You believe you cannot go back to work at your current job, but believe you could work in some capacity.

5. You have significant pre-existing disabilities.

6. You would like to dispute an adverse decision made by your employer, your employer’s insurance company, or your state’s workers’ comp division regarding your workers’ compensation claim.

7. You believe you are not receiving the correct benefits, or wonder if there are additional benefits you could receive.

8. Your medical benefits are denied.

9. Your employer has disputed a decision made by your state workers’ comp division.

10. You do not understand the workers’ comp process and would feel more comfortable if an expert were representing your interests.

Regardless of the circumstances of your workers’ compensation claim, you are entitled to obtain an attorney.

If your injuries are severe enough that your life will be permanently altered, either because of permanent bodily impairment or a change in ability to work, a workers’ comp lawyer will be able to advocate on your behalf to ensure that you receive the medical care and workers’ compensation benefits you are entitled to.

In addition, if your injury may keep you from working permanently, a lawyer can advise you about filing for Social Security disability benefits as well.

Most states offer vocational services to individuals that are unable to return to work in their former jobs due to an industrial injury. A workers’ comp attorney can assist you in navigating the system so that you are most likely to receive retraining or monetary payment to assist you while you obtain alternate employment.

If any aspect of your claim is in dispute with your employer, or your employer’s insurance company, it is important for you to obtain an attorney. In many states, the dispute process is highly legal, involving complex legal rules and procedures.

You will likely be at a disadvantage if you do not retain an attorney to represent your interests in these proceedings.

Remember that it is your right as an injured worker to visit any BWC-Certified Provider that YOU deem necessary.

The choice of care is actually determined by the injured worker. This is an important fact that the injured workers need to know.

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.

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

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