Injured Employee’s Right to Medical Treatment

By Luis Julia

Medical benefits pay for necessary medical care to treat your work-related injury or illness. Your employer’s workers’ compensation insurance carrier should pay medical benefits directly to the health care provider.

You may receive medical treatment immediately after the work-related injury or illness.  If your employer has elected to participate in the insurance carrier’s health care network (network), you are required to obtain medical treatment through the network if you live within a network’s service area.  You must select a doctor from a list of network providers, which you can obtain from your employer or insurance carrier.  If you want to change your doctor, you should contact the network or the insurance carrier for assistance.

If you are not covered by a network, you have the right to an initial choice of doctor, with the exception of doctors previously removed or denied admission to the state’s Approved Doctor List.  For assistance in locating a doctor who can treat your injuries, you should immediately contact the law offices of Bailey & Galyen at 1-855-747-4878.

After you have chosen a treating doctor, any request to change treating doctors must be approved by the local Workers Compensation Field Office handling your claim. If you or your treating doctor move or the doctor becomes unavailable to provide medical treatment, you will be allowed, without an order from the state, to choose another treating doctor. However, if you wish to change treating doctors for another reason, you will need to file a request with the state.

You will need to complete an Employee’s Request to Change Treating Doctors – Non-Network (DWC Form-53) with the local workers compensation Field Office handling your claim. For assistance preparing and filing a change of doctor request, please call us at Bailey & Galyen 1-855-747-4878. We will prepare the necessary form and include documentation to effectively change your treating doctor to a doctor of your choice.  Once the request is approved, notification goes out to all parties that your treatment is going to be managed by a different doctor. Your treating doctor, except in an emergency, must approve all medical treatment for a work-related injury or illness. Some medical services or treatment may require your doctor to obtain pre-authorization through the insurance carrier, or a representative of the carrier.

A doctor may not bill you for treatment of a work-related injury or illness. The doctor may send you a copy of the bill marked as “information only” upon your request.

The doctor cannot try to contact you for payment by: (1) sending you a bill when you did not request an information copy; (2) having a collection agency send you a letter or contact you; or (3) filing a lawsuit in court against you.  A doctor may only request payment from you when the injury or illness, through dispute resolution hearings or the Courts, has been finally determined to be an injury or illness that is not work-related.

As an injured employee, your right to receive effective medical treatment is the cornerstone of the workers compensation system.  As soon as practicable, you need to change doctors to a doctor of your choice, not one referred by your employer.  We at Bailey & Galyen will assist you in obtaining and doctor that will effectively treat your work-related injuries.  Call us now!!

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