Tuesday, January 27, 2009

Should You Let The Insurance Company Select Your Doctor For You?

You have the right to select the doctor who will be your primary treating physician during your Louisiana Workers’ Compensation claim. You also have the right to select any other medical specialists who will provide you with treatment during your claim. Some insurance companies may send you a list of "approved doctors" who are part of their network. You’re allowed to select one of their doctors from the list, but you’re not required to. As long as your doctors’ qualifications are reasonably related to your injury or illness, the insurance company should honor the doctor or doctors you select. You should be allowed to switch to a different doctor if you have a good reason for doing so.

Louisiana Revised Statute 23:1121 of the “The Louisiana Workers' Compensation Act” says:
The employee shall have the right to select one treating physician in any field or specialty. The employee shall have a right to the type of summary proceeding provided for in R.S. 23:1124(B), when denied his right to an initial physician of choice. After his initial choice the employee shall obtain prior consent from the employer or his workers' compensation carrier for a change of treating physician within that same field or specialty. The employee, however, is not required to obtain approval for change to a treating physician in another field or specialty.
But the law is very strict and you can easily forfeit your right to pick your own doctors.

Louisiana Revised Statute La.R.S. 23:1121 goes on to say:

If the employee is treated by any physician to whom he is not specifically directed by the employer or insurer, that physician shall be regarded as his choice of treating physician.

When the employee is specifically directed to a physician by the employer or insurer, that physician may also be deemed as the employee's choice of physician, if the employee has received written notice of his right to select one treating physician in any field or specialty, and then chooses to select the employer's referral as his treating specialist after the initial medical examination as signified by his signature on a choice of physician form. The notice required by this Subparagraph shall be on a choice of physician form promulgated by the director of the office of workers' compensation and shall contain the notice of the employee's rights provided under R.S. 23:1121(B)(1). Such form shall be provided to the employee either in person or by certified mail.
* * *
If the employee fails or refuses to sign the form . . . the employer or his insurer shall be entitled to seek an expedited hearing to be held within ten days, and upon order of the court, may suspend medical benefits until such time as the employee complies with Subparagraph (2)(b) and Paragraph (3) of this Subsection.
Nothing in this Section shall be construed so as to provide that a physician who, regarding the work-related injury, administered emergency treatment only shall be the physician of choice of either the employee or the employer.
Should you pick one of the insurance company’s doctors to be your primary treating physician?

Doctors have deep and genuine philosophical differences about how to treat people who are involved in Workers’ Compensation claims. They have strongly differing opinions about what type of injuries require surgery, what types of medications to prescribe and the types of work that injured people are able to perform. They seem to disagree about practically every aspect of treating people who are involved in Workers’ Compensation claims. Some doctors even seem suspicious of patients who were injured at work and filed a Workers’ Compensation claim. The most important thing is that you select a doctor that you have confidence in and feel comfortable talking to. Your ability to communicate openly with your doctor can have a huge impact upon your recovery and the type of treatment you receive.

The insurance company also has the right to set up occasional appointments with doctors that they have selected. In most cases, these appointments will be only examinations and the doctor will not provide you with any actual medical treatment. You are required to attend these appointments and the Workers' Compensation Court may suspend your benefits if you don't go. The insurance company isn’t allowed to send you to more than one doctor in each medical specialty without your consent. You should consult an attorney before agreeing to an examination with a second doctor of the same medical specialty.


David Buie is a Louisiana Workers Compensation Lawyer
representing individuals throughout Louisiana.
www.DavidBuie.com