Work Comp Corner is a regularly occurring column that will provide insight into how workers’ compensation works and address frequently asked questions. It is not meant to be legal advice. Please contact an RLS workers’ compensation attorney should you have specific questions regarding your potential case.
Q: Can my personal doctor treat me if I am injured at work or do I have to use my employer’s workers’ compensation doctors?
A: One of the benefits provided by workers’ compensation is medical treatment that is “reasonably required to cure or relieve” the effects of an industrial injury. However, there is a system of rules and processes that must be followed in order to utilize this benefit. Some employers may have what is called a Medical Provider Network (MPN) from which you must select a doctor. This is not always as straightforward as it may seem and will be the subject of a future “Work Comp Corner” column. Other employers allow you the freedom to choose any doctor so long as that doctor accepts payment from workers’ compensation.
Alternatively, if you have taken the appropriate steps before you sustain a work-related injury, then your personal doctor can provide treatment (i.e., predesignation):
1. Your personal doctor must be a medical doctor (M.D.) or doctor of osteopathic medicine (D.O.);
2. The doctor must have limited their practice to general medicine or is either a board-certified or board-eligible internist, pediatrician, OBGYN, or family practitioner; and
3. The doctor must have treated you prior to the work injury and retain your medical records.
So, for example, you cannot predesignate a chiropractor, a dermatologist, or someone you’ve never seen before.
There are three general conditions that must be met in order to properly predesignate a personal physician to provide treatment on an industrial basis:
1. You must provide written notice of the predesignation in writing to your employer before the injury occurs. Certain information must be set forth in the written notice or you can utilize a state form (DWC Form 9783);
2. You must have health care coverage for nonindustrial injuries; and
3. Your personal doctor must agree to be predesignated and this agreement must be documented in writing.
However, if your doctor is not familiar with the workers’ compensation system and the various rules and processes which govern the provision of medical treatment (i.e., all of the special forms, utilization review, etc.), it may not be the best choice to have your private doctor serve as your primary treating physician for your industrial injuries. A doctor who is familiar with workers’ compensation may be more effective in helping you obtain the care needed to recover from your work injury.
If you are considering whether predesignation is appropriate for you, we recommend you call our workers’ compensation team for a full discussion that contemplates your specific scenario.
About the author
Laura Stornetta is an attorney with the Injury Resource and Litigation Group, specializing in representing clients in workers’ compensation claims.
