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Medical Treatment

The doctor you choose to provide you with treatment for your work injury is one of the most important decision you will make related to your case. That’s right, you do get to choose your own doctor! If you have been told that you do not have a choice. You do not have to pay the doctor you have chosen. The insurance company is responsible for paying the doctor.

Why would you want to choose your own doctor?

This is the single best way to help take away the insurance companies ability to put their interests in front of the interests of you and your family. Trust me, they desperately want to control what doctors treat you for your injury. They have a financial interest in sending you to doctors who will save them money at the expense of your physical condition, emotional health and the financial well being of you and your family.

The last place you should seek advice about what doctor to go to for treatment is the insurance company. Don’t be fooled. Your interests are the complete opposite of the insurance company’s interests. They refer injured workers to the same doctors repeatedly for a reason!

There are many reasons that choosing your own doctor is so important:

1. You are more likely to get appropriate treatment

If you have ever been the member of an HMO you probably have experienced firsthand or heard of all the problems people have experienced getting past the "gatekeeper" primary care doctor to a specialist. The problem is so bad that President Clinton tried to pass new law giving patients a bill of rights. You already have this in workers compensation. You simply need to pre-designate a doctor or change to your own doctor as soon as the law allows.

In my vast experience a doctor chosen by the injured worker is more likely to request all the tests, therapy, medications, etc. that could help you than the doctor chosen by the insurance company. You are less likely to re-injure yourself if you are not forced to return to work too soon or with insufficient limitations on your activities as is often done by the insurance company’s doctors.

Although it saves the insurance company money if you are working and are not receiving temporary disability, it is often not best for your recovery. I have experienced too many cases where my clients were released back to work with little or no appropriate treatment or clear diagnosis only to re-injure themselves worse. I have also seen too many examples of clients who are released to work without sufficient work limitations resulting in longer healing periods and often unnecessary permanent injuries.

2.You are more likely to receive a fair settlement

I have explained in the Permanent Disability and Settlement sections of this website the tremendous effect your treating doctor has on the value of your case. It will be the words in this doctor’s P&S report that determine how much the insurance company has to pay you. Also, there is a presumption in the law in favor of the treating physician’s findings. This presumption is extremely pivotal in the outcome of most settlements.

You do not want the insurance company’s doctor to write the P&S report in your case. You want to change doctors first. Thus, this powerful legal presumption will be in your favor, not used against you.

3. You are more likely to be retrained when necessary

Your employer and the insurance company have a financial interest in you being returned to work after you are released by your treating doctor even if you can’t really do your job due to your injury. This is because they save the expense of having to retrain you. See the Career Retraining section of this website.

B. How do I choose my own doctor?

In most cases, you can not choose your own doctor until 30 days after you have reported your work injury. However, there are situations in which you can choose your own doctor immediately. First, you can re-designate your own doctor. Your employer is required by law to inform you of your right to pre-designate a doctor to treat you in the event you are injured at work by placing a placard in the work place which details this right. If you properly notify your employer, you can treat with the doctor you pre-designated immediately with no 30-day wait. Second, if your employer failed to post the required informational placard in your work place there is no waiting period.

Pre-designating a physician to treat you in the event you are injured at work is easy, you just need to notify your employer in writing.

Change of Doctors during Treatment

The third way to change your doctor can be used only when you are currently receiving treatment from the insurance company’s doctor. Simply send a letter to the insurance company that explains that you have chosen to switch doctors. Your letter must provide the insurance company with the name, address and phone number of the doctor you have chosen.

C. How do you know which doctors to choose?

Unfortunately, this I can not explain. The only way to know whom to trust is to be familiar on a daily basis with the specialists in San Diego. I know whom to trust because I have learned whom not to trust. So, if you are unsure I suggest you complete the Free Case Review and I will try to guide you.

D. What happens if I don’t change my doctor before I am made P&S

You do not have to just accept the findings of the insurance company selected doctor. You are entitled to another doctor’s opinion, called a QME. The method for getting a QME varies depending on whether or not you have an attorney. If you have made the mistake of not speaking to an attorney about your rights prior to this point, it is not too late. A lawyers understanding of the specific, technical ways to overcome the treating doctor presumption is invaluable. I suggest you complete the Free Case Review.