Choosing the right doctor to treat a work injury

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According to the U.S. Bureau of Labor Statistics, more than one in 33 American workers reported a substantial work injury or illness in 2012. Injured employees in Illinois have choices about the doctors and hospitals they visit. By discovering more about their rights and options, employees can secure the medical treatment they need for a full recovery.

Can injured workers choose their doctors?

Injured workers can pick their own medical providers in most cases. State law and employer choice may set some limitations on the number of specialists seen or the particular doctors available for consultation. It is important to learn about these limitations to avoid the risk of facing medical bills which may not be covered by workers’ compensation benefits.

Preferred Provider Programs

Illinois employers have the option of establishing a Preferred Provider Program with a pre-selected choice of doctors. If an employer has set up a PPP, injured workers may choose two physicians from the network. Employers who establish a PPP must notify their employees in writing with an official form provided by the Illinois Workers’ Compensation Commission.

Does the PPP network apply to all medical care?

Even if the employer has a PPP network in place, it does not apply to medical care in the following situations:

  • Emergency care in the immediate aftermath of an accident or injury
  • Medical treatment received before reporting the injury to the employer
  • Treatment received after the worker has chosen to opt out of the employer’s PPP network

If a head injury occurs in a slip-and-fall accident, for example, the employee is not only permitted but encouraged to seek treatment from the closest available doctor. PPP networks are designed to cover long-term care after an injury on the job.

How are employers allowed to opt out of the PPP network, and what are the consequences?

Employees may opt out of participation in a PPP network by notifying the employer in writing. This statement counts under Illinois law as a choice of medical providers, leaving the employee with the choice of a single doctor outside the PPP network. If this doctor refers the injured worker to further specialists, their services are also covered by workers’ compensation. Employees must seek written approval from their employers if they wish to see a specialist outside this chain of providers.

Navigating the health care system after a work-related injury can be complicated and intimidating. Get in touch with a legal professional today for advice on your situation.