Tag Archives: doctor choice

Limits on Medical Treatment Options for Injured Workers?

Doctor choice.  And choice of treatment.  The Wisconsin way.

Unlike systems in other states, an injured worker in Wisconsin has access to their own doctor and what that doctor recommends for medical care.  Wisconsin does not have specific directed care or a panel of worker’s compensation doctors. The choice of medical care and experienced practitioners produces some of the fastest return to work rates in the country, along with low costs per claim.

The only “limit” is the “two doctor rule,” where a Wisconsin injured worker has the right to see their own doctor or to get a second opinion from another doctor.  While any doctor beyond the “two doctor” limit would be excluded from coverage (unless mutually agreed to by the work comp carrier), a worker has the right to see any doctor that is part of the referral chain from the two doctors–making doctor choice virtually unlimited if the worker obtains an appropriate referral!

The recommended medical care should be covered by the work comp carrier is reasonable and necessary to cure from the effects of an injury.  Unless the insurance company has a contrary medical opinion (through an adverse, or “independent” medical evaluator), they generally are responsible for the medical treatment recommended, whether that is therapy, office visits, prescriptions, injections, surgery, etc. 

Other states place limits on the type of treatment a worker can receive.  A recent article revealed that Ohio legislators are limiting when injured workers can have certain prescription medications or surgery (Ohio Imposes Strict Rule on Workers’ Back Surgery, Opioids).  Ohio is required a worker undergo 60 days of “alternative care”, potentially without opiate use, before having a work-related back surgery.

To date, Wisconsin’s legislature preferred the medical expertise of its physicians and their treatment recommendations.  Relying on experienced, quality medical practitioners allows workers swift access to the necessary medical care and recommendations–and puts them back in the workplace fast!

 

Who Can Provide Worker’s Comp Medical Treatment?

Medical treatment expense now eclipses indemnity benefits paid in Wisconsin for worker’s compensation. The employer must supply medical treatment reasonably required to cure and relieve from the effects of the injury.

Treatment can be medical, surgical, chiropractic, psychological, pediatric, or dental and includes hospital treatment, medical and surgical supplies, crutches, and artificial members and appliances.

…Wisconsin employees have their choice of treating practitioners…

Unlike some states where the employees must obtain treatment from a panel of physicians, Wisconsin employees have their choice of treating practitioners (except in genuine “emergency” situations where the employer can choose). Ohio, for example, just announced it has expanded the list of providers who can treat injured workers and strengthen certification requirements for those providers.

Ohio’s Bureau of Worker’s Compensation expanded health care professionals to include adult day care facilities, anesthesiology assistants, independent diagnostic testing facilities, and sleep laboratories.

While in Wisconsin, the employee has a great deal of freedom of choice in selecting a treating practitioner, some limits apply. Practitioners must be licensed to practice in Wisconsin. Out-of-State treatment is compensable if Continue reading

You Have The Right To See Your Family Doctor

Your family doctor may be the best person to treat your work injury.

Today’s post comes to us from Brody Ockander of Nebraska. While he speaks specifically about Nebraska, the same rule of thumb applies here in Wisconsin. If you have an an injury covered by workers’ compensation, you have the right to choose your physician. Don’t let your employer tell you otherwise. 

Generally in Nebraska, if you’re injured at work, you have a right to go to your family doctor so long as that doctor has treated you or an immediate family member and has records of that treatment. See Neb. Rev. Stat Section 48-120(2)(a).

Furthermore, you may be able to treat with any doctor (not just your family doctor) if your employer doesn’t provide you with a “Choice of Physician Form” (also known as a Form 50—click to see here), or if your employer denies your work comp claim.

It’s most likely that no doctor knows your health better than your own family doctor.

What many employers will attempt to do, however, is have you sign a “Choice of Physician Form” and tell you that in order for work comp to pay, you have to write on the form that you choose to treat with one of their doctors (i.e. a doctor that has your employer’s best interest in mind and probably not yours) rather than your family doctor.

Other times, your employer may give you a Continue reading