December 19, 2013

Can I Choose My Own Workers' Compensation Doctor?


Importance of Attending Physician

Your workers' compensation doctor is extremely important for the smooth processing of your workers' compensation claim.  You will need to establish with a primary physician who will be your "attending physician."  This doctor will be the one to refer you to specialists, prescribe physical therapy and other treatment, and provide your work restrictions.  The attending physician also decides when you are medically stationary and what permanent impairment, if any, you have when the claim is closed.  These are all very significant benefits which is why it is so important to have a supportive and responsive attending physician.

An attending physician must be a medical doctor (M.D.) or a doctor of osteopathy (D.O.).  A nurse practitioner (NP or FNP) or a physician's assistant (PA) cannot be the attending physician.  It is common that you will be treated by a nurse practitioner or  physician's assistant when you first go to a medical clinic.  In fact, it is common that the clinic will not even clarify the type of provider you are treating with.  If you are unsure, just ask.

Under Oregon workers' compensation laws you can receive treatment and work restrictions from a nurse practitioner for the first 30 days of your claim.  If your fist few visits were with a nurse practitioner, don't panic.  But, plan to transfer care to an actual physician as soon as possible.

However, the official attending physician must be an M.D. or D.O. so it is best to establish with one as soon as possible.  I would recommend you request treatment by a doctor at your first appointment for this reason.

Choosing Your Workers' Compensation Doctor

Oregon law absolutely protects your right to choose your own doctor.  This means that you do not have to go to your employer's in-house medical facilities or to any place recommended by your employer.  You can choose to be treated by whomever you wish.  If your employer drives you to a specific clinic or tells you where to seek treatment, they are not following the law and you do not have to have treatment there.

Only you get to choose where to seek treatment!

You also do not have to treat with a provider in your private insurance network.  For example, if you have Kaiser insurance through your employer you do not have to go to Kaiser for your workers' compensation claim.  You can treat wherever you wish for your workers' compensation claim.

Can You Switch Attending Physicians?

Yes.  You can have up to three attending physicians throughout your claim.  So, if you are unhappy with a physician or need to switch to a different type of doctor, you can do so.  For example, it is common that you may begin treating with a general practitioner, but switch your care to your surgeon if you need surgery.  The surgeon would then be the attending physician.

You can have more than three attending physicians if there is special need.  For example, if your attending physicians retires, moves out of state, of dies, you would be able to have a new attending physician.

How is an Attending Physician Designated?

The most common way to designate an attending physician is via an 827 Form.  This is a form completed at the doctor's office.  It is also the same form used to file an initial claim, file an aggravation, or file a new medical condition claim.  There is a place where you or the doctor can check "change of attending physician."  This form is submitted to the workers' compensation insurer who then knows to look to your new doctor for work releases, etc.

However, an attending physician can also be established based on the record. So, if no 827 Form was completed, but you are regularly treating with a doctor for your claim and they are providing work releases, it would be determined as a matter of fact that the doctor was your attending physician.

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