After a workplace injury, you may already have a physician you trust or want to choose a specialist based on your own research. In an Indiana workers' compensation claim, however, injured employees generally do not have the same freedom to select their treating doctor that they would when using ordinary health insurance.
Indiana's workers' compensation system generally gives the employer or its insurance carrier significant control over authorized medical treatment. At Flores Law Group, we represent injured workers in Indianapolis who have questions about doctors, medical treatment, benefits, and disputes that arise after workplace injuries. Understanding who selects your physician can help you avoid decisions that could affect payment for your care.
Who Chooses the Workers' Comp Doctor in Indiana?
In most Indiana workers' compensation cases, the employer or its workers' compensation insurance carrier has the right to direct medical care.
That typically means the employer or insurer selects the authorized physician who evaluates and treats the injured worker.
This can be frustrating for employees who would rather see their family physician or choose a specialist themselves.
However, going to an unauthorized provider without understanding the consequences may create a dispute over who is responsible for the medical bills.
Our Indianapolis workers' compensation attorneys can help injured employees understand whether treatment has been properly authorized and what options may be available when problems arise.
What Does Authorized Medical Treatment Mean?
Authorized treatment generally refers to medical care approved or provided through the employer or workers' compensation insurance carrier.
Depending on the injury, treatment may involve:
- Initial medical examinations
- Diagnostic imaging
- Physical therapy
- Prescription medications
- Specialist consultations
- Injections
- Surgery
- Follow-up appointments
- Rehabilitation
The authorized treating physician can play a significant role in the claim.
That doctor may provide opinions concerning your diagnosis, work restrictions, necessary treatment, whether you can return to work, and when you have reached maximum medical improvement.
Because these opinions can affect both medical and wage benefits, disagreements over treatment can become significant.
What Should You Do Immediately After a Work Injury?
Report the injury to your employer as soon as possible and ask what you should do for medical treatment.
Do not assume you should simply schedule an appointment with your regular doctor.
If the employer directs you to a particular clinic or physician, keep records showing where you were told to go and who provided the instructions.
When you receive treatment, explain accurately:
- How the accident occurred
- What job you were performing
- Which parts of your body were injured
- When symptoms began
- Whether symptoms have changed
- Whether you have relevant prior injuries
Consistency is important.
Medical records created shortly after an Indianapolis workplace accident can become significant evidence if the employer or insurance company later disputes whether the injury was work-related.
Can You See Your Family Doctor Instead?
You can physically seek medical care from a physician of your choosing, but that does not necessarily mean the workers' compensation carrier must pay for it.
Indiana's employer-directed medical system can make unauthorized treatment financially risky.
There are circumstances in which treatment outside the employer's selected providers may become an issue worth examining, particularly when authorized care is inadequate, unavailable, or disputed. However, an employee should not assume that dissatisfaction with a doctor automatically creates a right to choose any replacement physician at the carrier's expense.
Before independently changing doctors, consider speaking with an Indiana workers' compensation attorney about the situation.
What if You Do Not Trust the Workers' Comp Doctor?
Some injured employees become concerned that the authorized physician is minimizing their symptoms or returning them to work before they believe they are ready.
Disagreement with a doctor does not automatically mean the physician is acting improperly.
Still, legitimate concerns should not be ignored.
Keep track of your symptoms and explain them clearly during appointments. Tell the physician which activities cause pain and whether your condition has improved, worsened, or remained unchanged.
You may also want to document:
- Symptoms discussed during appointments
- Treatment recommendations
- Work restrictions
- Medications
- Referrals
- Requests for additional testing
- Changes in your condition
If the medical records appear inconsistent with what occurred during the appointment, address the issue promptly.
Can You Request a Second Opinion?
Second-opinion issues can arise in Indiana workers' compensation cases, but injured employees should distinguish between requesting additional evaluation and independently obtaining unauthorized treatment.
Depending on the circumstances, there may be legal mechanisms for addressing disagreements about medical care or obtaining additional medical evidence.
The appropriate approach depends on the nature of the dispute.
For example, an employee may disagree with a physician about:
- Whether surgery is necessary
- Whether additional diagnostic testing is needed
- Whether the injury has healed
- Whether permanent impairment exists
- Whether the worker can return to full duty
- Whether symptoms are connected to the workplace accident
Before scheduling an outside evaluation and expecting workers' compensation to pay for it, determine what procedures apply to your claim.
What Happens if the Doctor Sends You Back to Work?
An authorized physician may release an injured employee to return to work with no restrictions or with temporary restrictions.
Restrictions might limit:
- Lifting
- Standing
- Walking
- Bending
- Repetitive movements
- Driving
- Use of an injured arm or leg
- Number of hours worked
If your Indianapolis employer offers work that complies with the authorized restrictions, refusing that work without legal or medical justification could affect your workers' compensation benefits.
On the other hand, employees should not silently perform duties that violate documented medical restrictions.
Keep a copy of your restrictions and communicate concerns when assigned work appears inconsistent with them.
What if Your Employer Will Not Authorize the Treatment You Need?
Disputes sometimes arise when a physician recommends treatment but the workers' compensation carrier delays or refuses authorization.
The worker may be left waiting for imaging, specialist care, physical therapy, surgery, or another form of treatment.
Document the delay.
Keep records of when treatment was recommended, what authorization was requested, and what responses were received.
Medical treatment disputes can affect more than recovery. A delay may also extend the amount of time an employee remains unable to work or works under physical restrictions.
An attorney can review whether further action is appropriate when necessary treatment is not being provided.
Can You Change Doctors During an Indiana Workers' Comp Claim?
Changing treating physicians is not always as simple as selecting a new doctor and making an appointment.
Because the employer generally controls authorized medical care, workers should proceed carefully.
If you have serious concerns about the treatment being provided, explain specifically what is wrong.
For example:
- Your symptoms are worsening
- Recommended treatment is not being scheduled
- The doctor refuses to address a significant symptom
- You need a specialist but have not received a referral
- There is a dispute about your work restrictions
- You believe your recovery has been incorrectly evaluated
Specific concerns are more useful than simply stating that you dislike the physician.
Legal guidance can help determine what options exist for seeking different or additional medical care.
What Is an Independent Medical Examination?
An independent medical examination, often called an IME, may be used to obtain another medical opinion concerning issues in a workers' compensation claim.
Despite the name, an IME should not automatically be viewed as the same thing as choosing your own treating physician.
The examining doctor may be asked to provide an opinion concerning diagnosis, causation, treatment, maximum medical improvement, impairment, or work capacity.
If you are scheduled for an IME, attend as required and provide accurate information.
Do not exaggerate symptoms, but do not minimize them either.
The physician's report may become important evidence in the workers' compensation case.
Who Pays for Authorized Workers' Compensation Medical Care?
When an injury is covered by Indiana workers' compensation, authorized and reasonable necessary medical treatment related to the workplace injury is generally handled through the workers' compensation system rather than ordinary health insurance.
This is another reason authorization matters.
If an employee independently seeks treatment that the employer or carrier did not authorize, a dispute may arise over responsibility for those expenses.
Keep copies of bills, explanations of benefits, receipts, and correspondence if you receive charges connected to your work injury.
Do not assume that receiving a bill automatically means you are ultimately responsible for paying it.
What if You Need Emergency Treatment?
Emergency situations are different from routine treatment decisions.
If you suffer a serious workplace injury requiring immediate medical attention, getting necessary emergency care should be the priority.
After the immediate emergency is addressed, the employer or insurance carrier may direct continuing treatment through authorized providers.
Make sure the workplace nature of the injury is accurately documented.
If possible, notify the employer promptly and preserve records showing when and how the accident was reported.
What if You Had a Preexisting Condition?
Having a preexisting medical condition does not automatically prevent an Indiana workers' compensation claim.
However, prior injuries and treatment can affect the medical analysis.
Be truthful with doctors about relevant medical history.
Trying to conceal a prior back, shoulder, knee, or other condition can damage credibility if earlier medical records later surface.
The important question may be how the workplace accident affected your condition.
Medical evidence can help distinguish prior symptoms from changes caused or aggravated by the work-related event.
Why Does the Choice of Doctor Matter So Much?
The treating physician can influence several major aspects of an Indiana workers' compensation case.
Medical opinions may affect:
- The treatment you receive
- Whether treatment continues
- Your work restrictions
- Your ability to return to work
- Temporary disability benefits
- Maximum medical improvement
- Permanent impairment issues
That makes disputes over medical care especially important.
Workers should understand what their doctors are recommending and keep copies of significant medical and work-status documents.
If you do not understand a restriction, diagnosis, or treatment decision, ask questions.
When Should You Speak With a Workers' Compensation Attorney?
Not every workplace injury requires a legal dispute.
However, speaking with an attorney may be appropriate when problems develop with medical treatment or the workers' compensation carrier.
Consider getting legal guidance if:
- Treatment is being denied or delayed
- You are being pressured to return to work too soon
- Your restrictions are being ignored
- You believe additional treatment is necessary
- The insurer disputes that your condition is work-related
- You have been released despite continuing serious symptoms
- You are unsure whether you can seek another medical opinion
- Benefits have been reduced or terminated
The earlier these issues are evaluated, the easier it may be to preserve evidence and determine what options are available.
Talk With Flores Law Group About Your Indianapolis Workers' Comp Medical Care
Indiana workers generally cannot choose any doctor they want and automatically require the workers' compensation carrier to pay for the treatment. Because employers and insurers typically direct authorized care, changing doctors or obtaining treatment independently should be approached carefully.
If you are dealing with a dispute over doctors, medical treatment, or benefits during an Indianapolis workers' compensation claim, our attorneys are here to help. Call Flores Law Group today or connect with us online to schedule a consultation.
