Who Choses the Doctor in a Workers’ Comp Claim?

After getting hurt at work, one of your first concerns is probably getting the right medical treatment. If you already have a doctor you know and trust, it may seem natural to make an appointment with that doctor.

In Missouri, however, workers’ compensation does not generally work that way.

Missouri law gives the employer the right to select the doctor or other healthcare provider who treats an employee for a work-related injury. Missouri requires workers’ compensation insurance and, in practice, the employer’s insurance company often handles the process of arranging or authorizing treatment.

That can come as a surprise to injured workers, especially when they are dealing with a serious injury and would prefer to see their family doctor or a specialist they already know.

You technically can choose your own doctor, but there is an important catch. Unless the treatment is authorized or another exception applies, you may have to pay for that doctor yourself.

Understanding this distinction can help you avoid unexpected medical bills and other problems with your Missouri workers’ compensation claim.

Who Chooses the Doctor in a Missouri Workers’ Compensation Case?

Under Section 287.140 of the Revised Statutes of Missouri, an employer is required to provide medical care that is reasonably necessary to cure and relieve an employee from the effects of a work-related injury.

The same law gives the employer the right to select the licensed treating physician, surgeon, chiropractor, or other healthcare provider.

This means your employer, or typically its workers’ compensation insurer acting on its behalf, can tell you where to go for authorized treatment.

Depending on the injury, that could mean sending you to an occupational health clinic first. From there, the authorized physician may recommend additional treatment such as physical therapy, diagnostic imaging, medication, injections, or a referral to a specialist.

When the treatment is properly authorized as part of a covered workers’ compensation claim, the employer or workers’ compensation insurer is generally responsible for the cost. According to the Missouri Division of Workers’ Compensation, authorized medical treatment, prescriptions, and medical devices are covered without a deductible.

Can I Just Go to My Regular Doctor?

You can, but you should be careful about doing so without first understanding how it could affect payment for your treatment.

Missouri law allows an injured employee to select his or her own physician. However, the statute also states that this treatment can be at the employee’s own expense.

In other words, having the right to see your own doctor is not necessarily the same thing as having the right to make your employer or its workers’ compensation insurance company pay that doctor.

The Missouri Department of Labor specifically warns injured employees that an employer and insurer generally have the right to choose the healthcare provider. The employer or insurer can authorize an employee to see his or her own doctor, so it is important to determine whether the treatment has been authorized before simply scheduling appointments independently.

For example, imagine you hurt your shoulder while lifting equipment at work. Your employer sends you to an occupational medicine clinic. Instead, you decide to make an appointment with an orthopedic doctor you have seen in the past.

Even if your orthopedic doctor provides excellent treatment, there may be a dispute over who is responsible for the bill if you did not obtain authorization to see that physician.

That is why injured workers should be cautious about assuming that workers’ compensation will automatically reimburse any doctor they decide to visit.

What If I Don’t Like the Doctor My Employer Chooses?

This is where the situation can become frustrating.

Maybe you feel like your concerns are not being taken seriously. Perhaps your symptoms are getting worse, but the doctor keeps telling you to wait. You might believe you need an MRI, a specialist, or additional physical therapy, while the authorized physician disagrees.

You can ask the employer or insurance company to authorize a different physician.

The employer is not necessarily required to grant every request for a different doctor, but asking for a change may be the first practical step when there is a legitimate problem with the treatment you are receiving.

It is also helpful to explain specifically what the problem is.

Saying, “I don’t like this doctor,” may not communicate much. Explaining that your pain has increased for six weeks, that you have developed numbness in your hand, or that you have repeatedly requested an evaluation of new symptoms gives a much clearer picture of the concern.

Keep records of these communications when possible. Emails, letters, appointment summaries, work restrictions, and medical records can help establish what treatment was requested and how the situation developed.

Can Missouri Workers’ Compensation Require a Change of Doctor?

There are circumstances in which a dispute over medical treatment can go beyond simply asking the insurance company for another doctor.

Missouri law provides that if there is reasonable ground to believe the medical care being furnished is endangering the employee’s life, health, or recovery, the Division of Workers’ Compensation or the Labor and Industrial Relations Commission may order a change in the physician, surgeon, hospital, or other medical requirement.

That does not mean every disagreement with a treating doctor will result in an employee being allowed to select a different physician.

The Missouri Department of Labor advises workers who are unhappy with their medical treatment to first raise their concerns with the insurance company. An employee may also seek assistance through the Division’s Dispute Management Unit or request a conference with an administrative law judge. If a Claim for Compensation has been filed, an employee may seek an evidentiary hearing concerning disputed medical treatment. Medical evidence can be necessary to establish the need for additional treatment.

For an injured worker who believes necessary care is being delayed or denied, getting legal advice can become particularly important.

What If the Doctor Sends Me Back to Work but I’m Still Hurt?

This is another common source of concern in workers’ compensation cases.

An authorized physician may release you to return to work even though you still have pain or other symptoms. Sometimes the doctor will provide restrictions, such as:

• No lifting more than 10 pounds
• No climbing ladders
• Limited standing or walking
• No repetitive use of an injured arm
• Sedentary or light-duty work only

Other times, an employee may be released without the restrictions he or she expected.

Do not simply ignore a medical release because you disagree with it. Instead, clearly explain your continuing symptoms to the physician and make sure the doctor understands what your job actually requires.

There can be a major difference between saying “I work in a warehouse” and explaining that your normal shift requires you to repeatedly lift 50-pound boxes, climb stairs, bend, twist, and remain on your feet for eight hours.

Specific information can matter.

If you believe a return-to-work decision is medically inappropriate, you may also want to discuss the situation with a Missouri workers’ compensation attorney before making decisions that could affect your benefits or employment.

What If I Need a Specialist?

The requirements work injury compensation in Missouri is typically more than a visit to an occupational medicine clinic.

A back injury might eventually require an orthopedic surgeon or neurosurgeon. A serious hand injury could require a hand specialist. A head injury may involve neurological evaluation. Other injuries may require physical therapy, diagnostic testing, pain management, or surgery.

In an authorized workers’ compensation treatment plan, referrals are generally coordinated through the authorized medical providers and the employer or insurer.

If you believe you need a specialist and one has not been provided, raise the issue rather than simply assuming the insurance company will eventually arrange it.

Ask your treating doctor whether a referral is appropriate. Describe any continuing or worsening symptoms. If recommended treatment or a referral is not being authorized, document what happened.

The Missouri Division of Workers’ Compensation specifically identifies disputes involving additional testing, specialist referrals, and surgery as issues that may be addressed when an injured employee believes necessary treatment is not being provided.

What About Getting a Second Opinion from Another Doctor?

Wanting a second opinion is understandable, particularly if surgery has been recommended or you disagree with a diagnosis.

The important issue is who will pay for it.

An injured worker can seek another medical opinion independently, but Missouri’s general rule allowing the employer to select the treating provider still applies. Choosing another physician on your own can leave you responsible for the expense.

Before scheduling an independent appointment, find out whether the employer or insurer will authorize it.

There can also be circumstances during a disputed workers’ compensation claim where medical evaluations are obtained for purposes beyond ordinary treatment. Those situations can involve different legal and evidentiary considerations, so they should not be confused with simply changing your treating doctor.

Will My Health Insurance Pay If I Choose My Own Doctor?

Do not assume it will.

A personal health insurance policy may contain provisions affecting coverage for injuries that should be handled through workers’ compensation. The Missouri Department of Labor specifically notes that health insurance may not solve the problem because some policies exclude work-related injuries.

You could therefore find yourself in an unpleasant situation where the workers’ compensation carrier says the treatment was unauthorized while your health insurer says the injury should be covered by workers’ compensation.

Before seeking significant treatment outside the workers’ compensation system, it is worth understanding who is actually going to be responsible for the bill.

Do I Have to Pay Medical Bills for Authorized Workers’ Comp Treatment?

Generally, authorized workers’ compensation treatment should not work like a normal doctor’s visit where you pay a deductible or copay.

The Missouri Division of Workers’ Compensation states that the employer or insurer is responsible for authorized medical treatment, prescriptions, and medical devices associated with the work injury. There is no deductible for the injured worker.

Missouri law also restricts healthcare providers from billing or attempting to collect certain charges directly from an employee for treatment of a covered work-related injury once the provider has received the required written notice. Treatment an employee independently selects at his or her own expense is treated differently.

If you start receiving medical bills for authorized workers’ compensation treatment, do not automatically pay them without finding out why you are being billed. Contact the employer, insurance adjuster, or your attorney if you have one.

Related: Workers’ Comp for First Responders in Missouri

What Should You Do After a Workplace Injury in Missouri?

Getting the medical treatment issue right from the beginning can prevent unnecessary complications later.

Report your injury to your employer promptly and ask where you should go for medical treatment. Make it clear that the injury happened at work and that you are requesting treatment through workers’ compensation.

Once treatment begins, be accurate and consistent when describing your symptoms. Tell your doctor when symptoms improve, but also tell the doctor when they do not.

Do not minimize what you are experiencing because you are worried about complaining too much. At the same time, do not exaggerate. Your medical records can become an important part of your workers’ compensation claim, and they should accurately reflect what is happening.

Follow reasonable medical instructions, attend appointments, and keep copies of work restrictions and important documents.

Missouri law can also affect benefits when an employee unreasonably refuses certain medical or surgical treatment. That is another reason to get legal guidance before simply stopping authorized treatment because you disagree with the physician or insurer.

When Should You Talk to a Missouri Workers’ Compensation Attorney?

Not every workplace injury turns into a dispute. Some employees receive appropriate treatment, recover, and return to work without significant problems.

Other claims become complicated quickly.

You may want to speak with an attorney if your employer refuses to provide medical care, the insurance company will not authorize recommended treatment, your symptoms are getting worse, you believe you need a specialist, you have been released to work despite serious limitations, or there is a dispute about whether your injury is work-related.

The same is true if you are considering going to your own physician because you believe the authorized treatment is inadequate.

Seeing your own doctor may feel like the simplest solution, but doing so without understanding the workers’ compensation rules can create a dispute about medical expenses.

Talk to a St. Louis Workers’ Compensation Lawyer About Your Medical Treatment

So, can you choose your own doctor after being injured at work in Missouri?

Yes, but the more important question is who will have to pay for that doctor.

Under Missouri workers’ compensation law, the employer generally has the right to select the authorized treating healthcare provider. You may choose another physician at your own expense, and an employer or insurer can also agree to authorize a physician you request. When disagreements arise about necessary treatment, there may be legal options for addressing them.

If you were injured at work in St. Louis or elsewhere in Missouri and are having problems getting the medical care you need, Ortwerth Law can help you understand your rights and the next steps available in your workers’ compensation claim.

A workplace injury can already leave you dealing with pain, missed work, and uncertainty about your future. You should not also have to guess about whether you are receiving the treatment Missouri workers’ compensation law provides.