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How to Avoid Conflict With Workers’ Compensation Doctors

If you want results, call us. If you want peace of mind, call us. If you want representation who understands the hardship that has been thrust upon you, call us.

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At DiMarco, Araujo, and Montevideo, we’ve seen plenty of workers’ compensation cases. Our attorneys and staff are all trained to deal with every aspect of a workers’ compensation case, including how to avoid conflict with your physician. If conflict with your physician is keeping you from obtaining compensation or negatively influencing how much you get, there are ways to alleviate the situation or avoid conflict altogether.

Conflicts Related to Physician Certification

Most states allow your own doctor to treat you for work-related injuries, though the nature of your insurance claim depends on the doctors your insurance company approves. Many of these doctors don’t have specializations in surgery, orthopedics, or other areas that would allow them to net the income they want from private practice alone. Thus, they work for insurance companies to supplement their incomes and may get a reputation for being “on the fringe” or less qualified than other physicians.

This isn’t always true, but in some cases doctors do take shortcuts. For example, some physicians may not use CAT scans or MRIs to diagnose a worker’s comp injury because that means the insurance company would have to spend its money on diagnostics. Some doctors don’t have access to advanced equipment, don’t keep up with medical literature, or hesitate to spend money on equipment and diagnostics.

If you suspect your physician is treating you with pain medication when you truly need advanced tests, seek a second opinion as soon as possible. If you can, wait 30 days after the initial claim, when you’ll be allowed an exam from any physician, whether or not he or she is on your insurance company’s approved list. Remember too that if your own doctor is on the list, you can seek treatment from him or her. Do so when possible, especially if you have built trust with this physician.

Being Labeled a Malingerer

To malinger is to fabricate illness or injury to avoid work. Ideally, no physician would accuse his or her patient of this, but some do so to remain on insurance companies’ approved list. This is often not malicious; again, these doctors are seeking a paycheck and often, ways to augment their earnings in a shaky economy. Other times, doctors run all the tests they should but can’t pinpoint the source of pain or discomfort.

Do not be afraid to push your doctor. If the prescribed medication isn’t working or if you think a scan or other test is needed, speak up. Additionally, don’t settle for increased medication dosages. Many pain pills can become addictive, so ask your doctor about alternatives to medication, such as advanced tests. If a worker’s comp injury is severe enough for surgery, your insurance company should point you to available approved surgeons.

Questionable Decisions

Workers’ comp injuries are all different, and every employee will be affected differently. Choose a physician who has experience treating workers’ comp injuries and who treats you as an individual. It’s your physician’s job to determine when you can return to work and what duties you can perform, as well as whether any of your injuries will cause permanent disabilities or restrictions.

To do this, your physician will need to give you several thorough exams depending on how long you’re out of work. If you return to work on doctors’ orders and are re-injured, or if you believe your physician made a questionable decision, there are several things you can do.

Seek a second opinion – again, after 30 days you aren’t obligated to stick to your insurance company’s approved list. Speak to your supervisor; he or she can lighten your duties or recommend more recovery time. Finally, speak to your insurance company and hire an attorney if necessary.

The attorneys at DiMarco, Araujo, and Montevideo want you to find a physician you’re comfortable with, not someone in the pocket of an insurance company. Contact one of our experienced attorneys to explain your rights to physicians