A doctor’s visit is necessary for a worker’s comp claim. In most cases, the DOL doctor you see will be assigned to you through your employer’s insurance. But what if you are unhappy with the doctor? Can you choose another?
Who Chooses My DOL Doctor?
If an emergency occurs, you can seek treatment from any doctor at any hospital. But if you need non-emergency care, most states will require you to see a doctor your employer selects. The doctor will belong to the worker’s comp insurance network.
Other states will let you choose your doctor. Some have more complicated rules.
Why You May Be Unhappy with Your DOL Doctor
They are Making Your Employer or the Insurance Company Your Priority: Your doctor is essentially hired by your employer and their insurance agency. They give him or her the work. Many doctors are aware of the relationship. They will downplay your illness or injury to keep money in the insurance company’s and employer’s pockets. This is one of the most common reasons why people choose to switch their DOL doctor.
They are Not Happy with the Service: Patients may also choose to switch their doctor because they are unhappy with the service. They may not like the way they were treated in the office. They may not think the doctor is knowledgeable enough. Or they may feel the doctor is too far for them to travel to.
Can I Switch My DOL Doctor?
The short answer is, yes, you can switch your DOL doctor, but must comply with the regulations of your state.
Some states will only allow you to switch your doctor once. Other states will allow you to do so multiple times.
In Florida, North Carolina, Virginia, and New Jersey, you can ask for a new doctor, but the insurance company will pick one for you.
There’s also a possibility that your request to change a doctor will be denied. You can appeal the decision. But the process will drag out the case and interfere with your ability to heal and receive compensation.
A Waiting Period is Involved
States like Pennsylvania and Michigan will allow you to switch physicians, but you must wait 90 days. The waiting period gives the insurance company time to process the change. Once the change is approved, you can seek treatment from any doctor you wish.
If you don’t wait 90 days and start seeing a doctor before your request is approved, you will be responsible for treatment costs.
Other states, like California, will only process requests for a DOL doctor change within 30 days. After that point, they will assume you are happy with the provided care.
How Many Changes Can I Make?
Most states put a limit on the number of changes you can make. In Illinois, you can change doctors twice without the insurance company’s permission After that, you can switch your DOL doctor only with the insurance company’s approval or under a court order.
In Georgia, you can only switch your doctor once.
If you hit your limit on the number of times you switch your DOL doctor and are still unhappy with the care you are receiving, you may consult a worker’s comp attorney. They will tell you how to move forward.
Working with a Managed Care Organization or Network Provider
Many employers work with a managed care organization (MCO). An MCO is a network of worker’s comp physicians. It is a popular choice because it reduces employer expenses.
If your employer works with an MCO or network provider, you may switch doctors, but the doctor you see must be part of the network or organization.
Can I Get a Second Opinion?
If you cannot change doctors, you may get a second opinion from another doctor.
Second-opinion doctors do not provide ongoing care. Rather, they perform a one-time checkup. They review your medical records and assess your treatment, restrictions, and limitations.
A second opinion doctor’s report will be included in your worker’s comp claim review. It can also be used as evidence in a hearing if your claim is denied.
The process for getting a second opinion varies from state to state. Typically, if your claim has been denied, your insurance company will not pay for a second opinion. Your lawyer will choose a doctor for you.
You may need to cover the cost of the appointment, but you will be reimbursed if you win your case.
Tips for Choosing a New DOL Doctor
If you have the option of choosing a new DOL Doctor, it’s essential to find one you can trust. You may be unable to switch doctors again. And even if you can, finding a new one will drag out your case and delay your treatment and compensation.
Look for a doctor that:
- Has experience treating your medical condition
- Is willing to testify on your behalf if necessary
- Has extensive experience in the field
How to Ensure Your Medical Visits are Successful
Patients can also do their part to ensure their DOL doctor visits are successful. Here are some useful tips:
- Be Honest: Be honest with your doctor. Be open about previous health conditions. Doctors are trained to spot signs of dishonesty. It’s essential to disclose all health facts, even if you think they may hurt your case.
- Report New or Worsening Symptoms: If you experience new or worsening symptoms, report them to your doctor right away. The doctor will create a report which serves as evidence of your condition. It will be useful in your claim.
- Keep Copies of Your Medical Documentation: Don’t count on your DOL doctor to keep track of your medical records. Keep your copies as well. They will work as backups in unforeseen circumstances. They will also be more accessible.
If you are unhappy with your DOL doctor, you may request a new one. The process varies from state to state. In the best circumstances, you will find one that helps you win your claim.