Can You Choose Your Own Doctor Under Minnesota Workers’ Compensation Law?

When you get hurt at work in Minnesota, workers’ compensation laws help cover medical bills and lost wages. A common question among injured workers, however, is whether they are allowed to choose their own doctor. The answer is yes, but with some limitations, and a Minnesota workers’ comp lawyer can help you work out exactly what rights you have under the law.

How Doctor Choice Works Under Minnesota Workers’ Comp

If you are injured on the job in our state, you do generally have the right to choose your own doctor. This could be your primary care doctor or a specialist who is familiar with your injury. The law supports you in this choice so that you can receive the personalized care you need to get the best recovery. However, there are some rules that have to be followed.

Once a doctor has treated you twice for your work injury, they automatically become your “primary healthcare provider” under the law. If you want to change this doctor, you can do so once within the first 60 days of treatment without needing any permission. If you want to make a change after 60 days, however, or want to make a second change, you’re going to need approval from your employer’s insurance company or from a workers’ compensation judge.

Limitations

There are some limitations on picking your own doctor. If your employer has a certified managed care plan, for example, you will have to choose a doctor who is within their network. These plans are all approved by the Minnesota Department of Labor and Industry. If your employer does not have a managed care plan, you can then select any qualified doctor.

Another limitation involves the treatment that you can be given. No matter who you select as your doctor, that doctor must follow Minnesota’s workers’ compensation treatment parameters. These parameters set the standards for what can be considered reasonable and necessary in your care. To get treatment beyond these standards, you usually have to get a special exception.

Why Choosing Your Doctor Matters

Since you have the freedom to pick your doctor, you should use it. There are a couple big reasons this is important. First, a doctor that you know and trust will know your medical history better, and there is likely to be better communication between you. Better communication means more effective treatment.

If you need a specialist, such as an orthopedic surgeon if you have a broken bone that requires surgical repair, having choice means you can select someone who has experience in the precise type of injury that you have suffered. You might also choose a doctor for commuting reasons: if a doctor is closer to your home, this could save you time and money when you have to go for treatment.

If you don’t choose your own doctor and go with whatever doctor your employer suggests, this can be a problem. For one, once that doctor has treated you twice, they become your primary provider and your options become more limited. For another, you don’t know the priority of an employer-suggested doctor. That doctor may be more interested in minimizing expenses on your employer’s behalf or for the insurance company than actually getting you the full treatment that you need.

Changing Your Doctor After t he Initial Choice

As stated above, if you need to change within 60 days, and you haven’t done so already, you can change doctors without any need to get approval from the insurance company. This rule is in place so that if your work injury is an emergency situation, and you thus aren’t initially able to choose your doctor, you still have the freedom to move to a doctor you trust once your condition has stabilized.

If you let those 60 days go by, however, things get trickier. Now you have to ask permission from your employer’s workers’ compensation insurance company. If they agree, you can see a new doctor. If they deny your request, you either have to let it go or ask your lawyer to help you take it to court and get a workers’ compensation judge to decide. This will mean attending a hearing where you explain why you want a different doctor, and you won’t want to attend this hearing without a lawyer who can argue your case.

Handling Disputes

The insurance company might claim that your doctor’s treatment isn’t necessary or that it’s too expensive, and they may try to use Minnesota law about treatment guidelines to make this claim. If your doctor insists that something is necessary, but the insurer disagrees, you may have to get an independent medical examination (IME).

In an IME, a different doctor, chosen by the insurance company, evaluates you and your injury as well as your medical records to decide if the proposed treatment is needed. T he IME doctor doesn’t become your treating physician, but their opinion will have a big say in whether your treatment is approved. If you disagree with the IME results, you can challenge them by requesting a hearing with a workers’ compensation judge.

Managed Care Plans and Their Effect

As mentioned above, if your employer has a managed care plan, your doctor choices do get a bit limited because you have to pick out of the network. Your employer will provide you with a list of doctors in the network, and you’ll need an exception if you want to go outside it. (An exception might be given, for instance, if you needed a specialist and there was no specialist of that type within the network).

Bear in mind, however, that even if your employer is in a managed care plan, you can always request a second opinion if you’re unhappy with the treatment you’re being given. The plan has to allow this, though the second doctor is usually still required to be within the network. One of the first things to find out after you’ve been injured is whether your employer has a managed care plan so you can understand all your options right from the beginning.

Importance of Documentation

Keeping good records is key whenever you’re dealing with workers’ compensation. There could be many reasons why you’ll need to request a different doctor or bring an appeal, and you will need all your medical records, all bills, and any letters that you’ve had from the insurance company to effectively make a case to protect your rights.

It’s also a good idea to track your symptoms and discuss your treatment in a journal. Note the dates of all your doctor visits and go over what you discussed with the doctor at that time and how you feel. This can help your doctor and lawyer build a strong case for you if there are any disputes, because, the clearer the record is, the easier it will be to prove that your doctor’s treatment is reasonable and necessary.

Working With a Minnesota Workers’ Comp Lawyer

Trying to deal with all of this can be very difficult and frustrating, but having a Workers’ compensation lawyer can help a great deal. Your lawyer will make sure you always know what your rights are, gather all needed evidence, and represent you in hearings and appeals.

For help from an experienced workers’ comp attorney, contact the Atkinson Gerber Law Office as soon as possible in Minneapolis or St. Paul.