If you’ve been injured on the job or have a chronic work-related condition, the doctor who treats you will play an important role in helping you recover as fully as possible and get all of the workers’ comp benefits you’re entitled to receive. Having a good treating physician is invaluable, but many states limit your ability to pick your own doctor, at least at first. Your ability to switch doctors may also be restricted, depending on your state and your employer’s arrangement for workers’ comp medical treatment.

Can You Choose Your Own Doctor After Your Injury?

Each state has its own rules for where injured employees may seek medical treatment. Except for emergency care, you need to follow the rules in your state in order have your medical costs covered by workers’ comp. The specifics vary from state to state, but there are three general types of arrangements for choosing the initial treating doctor:

• Choosing from a limited pool. Many states allow employers or their insurance companies to contract with some type of managed care organization or preferred provider plan for treating work injuries. Your employer should tell you if it has a plan like this. Some other states, like Pennsylvania, allow your employer or its insurance company to give you a list of providers. Either way, you’ll pick your treating doctor from the network or the list.
• Employee’s choice. Several states—including New York, Texas, and Ohio—allow you to choose your own doctor. Typically, however, that’s only true if your employer’s insurer doesn’t have a network contract for workers’ comp. And you may have to choose from your state’s list of approved physicians for workers’ comp. Your state could have other requirements as well. For instance, California lets you designate your regular primary care physician as your workers’ comp treating doctor, but only if you notified your employer about that preference before you were injured. In Texas, you may keep seeing your primary care doctor in your workers’ comp case as long as that physician is part of your regular employer-provided HMO.
• Employer’s choice. In some states, like New Jersey and Florida, you’ll have no choice in the matter; your employer will send you to a doctor or clinic for treatment of your work injuries. The only exceptions may be in emergencies or if your employer doesn’t provide treatment after you’ve asked for it.

Can You Switch Workers’ Comp Doctors?

If your employer’s insurance company had a big role in choosing your treating doctor, you may not be happy with that choice. Maybe you feel like the physician is more interested in saving the insurer money than getting you the best treatment you need. And no matter who made the initial decision, at some point during your recovery, you might become dissatisfied with the medical care you’re receiving.

Just as states have different rules for choosing your treating doctor in the first place, they have varying requirements for switching physicians. For example:

• When you’ve had to choose from a network or list of providers, you usually are allowed change to another doctor within the same network or from the same list. But there’s often a limit on the number of times you may switch. In Illinois, for instance, you may change to another network doctor once during your workers’ comp case; if you initially chose an out-of-network doctor (which you’re allowed to do), you can’t switch without getting approval.
• Several states allow you to switch doctors only after you’ve treated with the initial doctor for certain period of time. In Pennsylvania, you may switch to any doctor after 90 days, as long as you give the insurance company written notice. In Florida, you only have to see the initial physician once before requesting a change, but the insurance company will again pick your replacement doctor. In New York, you may change to any authorized physician outside of your employer’s network 30 days after your first doctor visit.
• You might need to get approval before you may change treating doctors. In North Carolina, for instance, if you want to switch from the insurance company’s doctor to one of your choosing, you must file a request with the state workers’ comp agency and prove that you need the change for your recovery.

What to Look for In a Treating Doctor

If your state allows you to pick your own treating doctor in your workers’ comp case, it makes sense to do so. A good doctor will make sure that you get as much time as you need to heal, instead of rushing you back to work before you’re ready. Your physician will also play a major role in determining whether you get permanent disability benefits and, if so, how much.

Whether you’re limited to a managed care network or can choose any physician who’s authorized to treat workers’ comp injuries, do your research and consider whether the doctor:

• accepts workers’ comp patients and your state’s fee schedule
• is certified in the appropriate medical specialty
• is familiar with your type of injury or condition, and
• understands the workers’ comp system and can support your claim by preparing detailed reports and testifying at a hearing if that’s necessary.

Getting Help

It’s important that you follow your state’s rules for selecting the doctor who will treat your work injury. Otherwise, your employer’s insurance company may refuse to pay the bills. If you need help figuring out those rules, you may be able to get information through the workers’ compensation agency in your state. An experienced workers’ comp lawyer can also help you navigate the system and get the medical care you need. And when you have any choice in your treating physician, your attorney may also be able to recommend a good doctor who can provide proper treatment and be a strong advocate for your recovery and right to benefits.