Workers’ Compensation and Your Doctor’s Office- What You Need To Know

Injured workers in Massachusetts can end up being referred to any number of different medical practitioners as they recover from a workplace accident. Most injured people can trust that their treating provider is acting with their best interests in mind.  However, with increasing frequency, we have seen workers’ compensation insurers attempt to insert themselves into the treatment relationship between a patient and the doctor. This is done to control claim costs and limit the benefits and medical treatment that the insurance company is required to provide.  

Doctors and other medical providers are often unaware of their obligations to the insurer. Your doctor could mistakenly cause serious damage to your case by providing more cooperation than is required. Sometimes  cooperation may conflict with your doctor’s  duties to you as a patient.  More than ever, it is important to be aware of your rights to medical treatment. You need to know about tactics used by workers’ compensation insurers to limit your treatment or reduce your benefits through communication with your treating doctor.

Many employers in Massachusetts have established relationships with occupational health clinics. A company will send an injured worker to a clinic after an accident.  Though these clinics can be helpful in giving you quick access to medical treatment, you need to be careful in using them. Sometimes the clinic will put the employer’s interests before those of the injured worker who is the actual patient.  The employer is the clinic’s customer. Often these clinics will prematurely release a patient for work even if the patient is not yet capable of performing job duties.  When that happens, an injured worker's weekly compensation can be stopped or reduced. Premature return to work may increase the risk of worsening your underlying injury.  If you are injured at work and your employer sends you to their occupational health clinic, you are legally obliged to attend only one visit.  Otherwise, subject to limited restrictions, you are allowed to treat with the doctor of your choice after an injury at work.

Even if you are comfortable with the treatment you are receiving after an injury at work, whether at an occupational health clinic or with a provider that you choose, it is important to be aware of other ways insurance companies may try to become involved with or interfere with your treatment.  One common example is the use of a nurse case manager.  Often an injured worker will hear from one of these nurse case managers, who may present themselves as advocates. A nurse case manager might tell an injured worker that she can help obtain access to medical treatment.  And while these nurses may be helpful, their actions will often reveal that they are acting more in the best interests of the insurance company than your own.  Too often these “advocates’” efforts seem to focus on convincing the treating doctor to release the injured worker to go back to work as opposed to making sure that they are getting the appropriate treatment.   If you are contacted by a nurse case manager, you should know that you are not required to work with them. You can request that they not contact you or attend your medical appointments.

Though you may refuse nurse case management, the nurse or handling claim adjuster may still attempt to communicate with your doctor’s office.  It is important to be aware of this possibility and the impact it may have on your case.  A workers’ compensation insurer is entitled to receive your medical records to confirm that medical bills are related to the injury you sustained at work. The insurance company adjuster will look at medical records to document that you remain unable to return to your job.  Some nurses or adjusters, however, go a step  further and will call the injured worker’s doctor to attempt to get the doctor to change work restrictions or out of work status.  We have even seen instances in which a claims adjuster has sent a drug testing kit to the treating physician with a request that they perform a drug test on the injured worker.  Finally, insurers sometimes also ask the treating doctor to order what is known as a “functional capacity examination.”  This is a lengthy, one-time examination, typically done by a provider who has never seen you before.  The exam is physically taxing and often results in a report that clears the injured worker for work that is far more demanding than what their own doctor would allow.  Your doctor is under no obligation to comply with any of these requests. But your doctor may not know this.  As a patient, you can protect yourself by having a frank conversation with your doctor about limiting communications with the insurance company to only those that are necessary.  It is perfectly reasonable to ask your doctor to refuse to discuss your condition, treatment plan or restrictions with a representative from the insurance company.  Likewise, you should refuse any treatment, testing or examinations that the insurer requests your doctor to initiate until you have a chance to review the request with a workers’ compensation attorney.

You need to protect yourself and safeguard your rights. Speak with an experienced, qualified workers compensation lawyer about your unique circumstances.

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