Do I have a right to my own medical care, or can the insurance company decide?

Answer

You certainly have rights with respect to who you see as your doctor for your work-related injury. There are specific rights you have to choose your physician in the first instance, and the insurance company can’t dictate that for you. Oftentimes, insurance companies or employers have a policy or a relationship with a certain medical facility where they encourage or tell all their injured workers to go to a specific place—but you don’t have to. Number one, you have the right to your own physician, but again, you need to have someone to enforce those rights and explain that you do have the right to your own doctor. The only exception is that from time to time, the insurance company does have the right to have you examined on a single one-time basis by a doctor of their choosing. They often refer to that as an “independent” medical examination or IME. There’s nothing really independent about it—the insurance company hires and pays this doctor, who is performing the examination for the insurance company, and there are many reasons why that can result in the insurance company doctor perhaps interpreting or finding things that benefit the insurance company more than they benefit you. You do have to go to these so-called independent medical examinations—we call them insurance or defense medical examinations at our firm—but you must comply, and I always tell my clients to be cooperative because you don’t want to go into these examinations with an attitude just because it’s the insurance company hiring them. You also want to talk to your lawyer both before and after your examination by an insurance company doctor because sending you for that type of examination, although it’s their right, can often forecast what’s to come in your case—whether it’s an attempt to stop your benefits, deny a surgery or treatment, or take some other action based on the doctor’s report. Also, when you’re sent to an insurance company doctor, you’re entitled under the Workers’ Compensation Act to a full and complete copy of the report once the insurance company receives it, but often they don’t provide it, especially if you’re not represented, and you may be left wondering what that doctor said. The insurance company can delay that if you’re not represented. There are also other rights involved—such as being entitled to mileage reimbursement for driving to and from these appointments—and again, these are just examples of rights spelled out in writing under the Act that you might not know about, and even if you do, you may not know how to go about enforcing them, getting that report promptly, or preparing properly before and after the examination to protect yourself.

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