Visitor Question

Why won’t my doctor see me after work injury?

Submitted By: Jason (Spring, Texas)

On Aug 7, 2017, I was exiting an F-150 to complete an inspection. It was raining so I pulled it in to a covered area. The floor is waxed for the sales. I stepped on the floor and my feet slipped out from under me. I hit my lower back on the running board and my right hip on the cement floor.

I have been going to the workman’s comp doctor. He has done an MRI and given me physical therapy. Now they are saying that my 2 small bulging discs and my right hip pain were not caused by the slip and fall. The doctor spends about 2 minutes with me every visit, and rarely even turns to look at me. I am 39 years old and have never had any pain until the fall. They are telling me it is due to me getting old.

My primary doctor will not see me and I don’t understand why. Workman’s comp stated that I can see any doctor I want, but it might not be paid by them. I feel like they are about to release me to full active duty, but I know that my body cannot perform the same duties.

I would like to know why my primary doctor will not see me? I can’t sit or stand for very long before being in pain.

Disclaimer: Our response is not formal legal advice and does not create an attorney-client relationship. It is generic legal information based on the very limited information provided. Do not rely upon the information in our response, or anywhere else on this site, when deciding the proper course of a legal matter. Always get a personalized case review from a local attorney.

Answer

Dear Jason,

At the outset of your injury, you are required to choose a treating physician from the insurance company’s list of approved physicians. Your employer has this list, and it is updated every three months. The insurance company, doctor, or hospital is strictly prohibited from billing you for any approved medically necessary treatment or services related to your work-related injury or illness.

The workers compensation insurance carrier is correct in stating you may have to pay the costs of your own physician. However, if it is later determined your injury was the direct result of the on-the-job injury, and the treating physician you were sent to improperly diagnosed your injury, they will likely have to reimburse you for those costs.

Your treating physician oversees your treatment and makes referrals to specialists if needed. The insurance company may require you to get prior approval for certain treatments or services so it can decide if the additional care is medically necessary. However, if you use a physician or hospital not on the insurance company’s approved list without approval, the insurance company may deny payment and you might have to pay the bills yourself. There are exceptions for emergencies and other situations.

It is apparent your primary treating physician is not affording you the time and care you require. You have a right to request a change in primary treating physicians. To do so, you need to complete and submit form DWC053: Employee Request to Change Treating Physician.

In the event you are not satisfied with the determination made by the physicians or the insurance company, seek the advice and counsel of several workers compensation attorneys in your area. Most will not charge for initial office consultations.

The above is general information. Laws change frequently, and across jurisdictions. You should get a personalized case evaluation from a licensed attorney. Find a local attorney to give you a free case review here , or call (888) 647-2490.

Best of luck,

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