How Is Medical Treatment Handled Under Workers Compensation?

A number of questions often come up with a person is injured at work. One of the first questions often becomes "how is medical treatment handled under workers compensation?" Here is a general explanation of a workers choice of medical care and who is responsible for paying for the medical care necessitated by a work related injury.

If the employer is paying for the medical bills, the employer gets to choose the doctor.  Subject to an exception, if the injured worker seeks treatment from an “unauthorized” doctor, the employer is not required to pay the bill. 
If the injured worker is not satisfied with the medical care provided by the employer’s chosen doctor, the injured worker can petition the Workers’ Compensation Commissioner’s Office for alternate medical care.  The injured worker must show at hearing that the employer provided care is unreasonable.  This usually consists of a medical opinion from another provider. 

Alternate care can also be sought in these situations:
  • When the treating doctor has no further care to offer, yet the injured worker is still experiencing symptoms. 
  • When an employer refuses to authorize a referral for testing or to a specialist. 
  • If the claimant is unduly inconvenienced by being made to travel for care when suitable care is available locally.
An injured worker is entitled to an independent medical evaluation (IME) at the employer’s expense.  If an authorized treating doctor has provided a permanency rating, and the claimant believes the rating is too low, or incomplete in some manner, the injured worker can get their own permanency evaluation done.  This a one-time, second opinion from a doctor of the injured worker’s choice, regarding the permanency of the injury. 

An IME is not available at the cost of the employer if they are denying liability.