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Can you change your attending physician for a workers’ comp claim?

On Behalf of | Dec 11, 2023 | Workers' Compensation |

Workers’ compensation may not work exactly like health insurance, but there are similarities between the two. Both can cover the medical expenses of an injured person. Still, workers’ comp differs in that it also covers a worker’s lost wages plus any other benefits for partial or permanent disability.

In health insurance, a policyholder usually can’t just pick which attending physician they can receive treatment from because they have to select a doctor from their insurer’s network. Is it similar to workers’ compensation in Connecticut? Can workers pick their own attending physician for a claim they filed?

Initial treatment is up to the employer

When a work-related injury occurs, a worker should receive all proper medical treatment, with the employer responsible for providing the initial treatment at a medical office or facility of the employer’s choice. After this first treatment, the employee can pick their attending physician – but there are limitations.

Adhering to the medical care plan

If an employer has a medical care plan and a list of approved medical providers, the employee must accept their first treatment from a plan-approved provider. All later medical treatment must also come from a plan-approved provider, per the state’s rules. Employees can only pick from their employer’s network of approved medical providers.

Refusing the initial employer-provided medical care or any plan-approved medical providers may lead to an administrative judge suspending the employee’s rights to compensation and benefits.

However, if the employer doesn’t have a medical care plan, the employee may choose any licensed medical practitioner in Connecticut.

Changing physicians

Workers are free to change their attending physician if they’re dissatisfied with their treatment. There are three ways for an employee to initiate a change:

  • Referral: The employee must first secure a referral from their current physician for a change in doctor.
  • Approval: The employee must obtain approval from their employer’s workers’ comp insurer. If the company is self-insured, the employee must obtain approval from their employer instead.
  • Appeal: A worker can write a request to the administrative judge in their respective district office requesting a new physician.

If workers don’t secure any of the three, they’ll have to pay out-of-pocket for their “unauthorized” medical bills.

So, can you change your doctor in a workers’ comp claim? You can, but there are limitations based on whether your employer has a medical care plan. However, even if your employer doesn’t have a plan, your claim for medical reimbursement isn’t guaranteed approval. Consider working with an experienced legal professional if your claim faces staunch disapproval.