Common Rules for Doctors in Workers Compensation Cases

Doctors to a certain extent run their practice they way they want to, as they can choose the types of cases they take and use different methods for different patients. However, they also have to play ball, so to speak, with a number of different regulators.

From being approved to working with a certain insurer to keeping their medical license, they have a lot to consider. We'll look at how workers compensation plays out for them. 

State to State 

There is a lot of misinformation out there about how doctors treat workers compensation patients, and much of it has to do with the fact that each state has their own rules. For example, in California a worker can have their regular doctor treat their injury if they had their own health insurance at the time they were hired and if they had already told their employer about their doctor before being injured.

In other states, the employer may choose the doctor as a way to ensure there is no fraud or the worker may be able to choose any doctor that's in their network. 

Insurance and Billing

A doctor has to follow a very complex set of rules should you go to him or her with a work-related injury, and the billing gets confusing quickly. Though a patient can typically go to any doctor as the very first consultation (or the ER should it be deemed necessary), a doctor may refer them to someone else for additional treatment.

Also, in certain states it may be possible to receive care from a PA or an RN for treatment while in other states one may be required to see an MD or DO, and the care may be limited. Say a worker has chronic back pain (to take one of the most common scenarios of injury), and they want to see a specialist like a chiropractor or massage therapist for relief. The insurance may cover only a few sessions at most. 

Finding a Doctor 

As an employer, it's easy to want to use all the power that you have available to you. In many cases if you live in a state that allows you to make the decision, it makes sense to find a doctor that will be fair to your employees, but who will never recommend treatments they don't need. Ultimately this should lower your insurance and make you less of a risk.

However, it's also worth noting that when a doctor doesn't have a history with a patient, they're liable to make mistakes. Those mistakes could very well leave you liable to additional compensation if something goes wrong and the worker never fully recovers. 

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