Can You Choose Your Own Doctor for a Virginia Workers’ Compensation Claim?
Generally speaking, you do not have the ability to choose your own doctor in a workers’ compensation claim. For injured workers in Virginia, understanding how medical treatment works under the Virginia workers’ compensation system can protect both your health and your claim. The rules governing who you can treat with are not entirely clear and the consequences of choosing the wrong provider can damage your claim.
The “Authorized Physician” Rule in Virginia Workers’ Compensation
If your injury is not initially serious enough to require hospitalization the carrier may send you to a “doc in the box” or urgent care facility. That facility may then guide you to a specialist to treat your injury. At this point it is important that an injured worker knows that they are entitled to choose a specialist or doctor from a panel of three provided by the workers’ compensation insurance carrier. This is something that you must request. If you accept treatment from a physician from direct referral from a general practitioner and you embark on treatment then that may be the authorized treating physician and you may be stuck with that doctor. You must request a panel at the early stages of your medical treatment. If you request a panel and they refuse to provide one then you may have the right to choose your own doctor. Usually, however, the insurance carrier will provide that panel when requested.
Virginia law generally requires that medical treatment be provided by an authorized workers’ compensation doctor, meaning a physician who has been authorized to provide treatment for your workers’ compensation claim. The process typically begins with your employer or their insurance carrier providing you with a panel of physicians from which you must select your treating doctor.
This panel requirement is not a formality. Choosing from the panel is how a doctor becomes your authorized treating physician for purposes of the claim. Once you make that selection and begin treatment, that doctor generally becomes the primary medical provider responsible for diagnosing your condition, recommending treatment, and documenting your work restrictions.
When You May Have Some Choice in Selecting a Doctor
If your employer fails to provide a proper panel of physicians after you report your workplace injury, you may have the right to select your own doctor. However, this situation can be legally nuanced, and it is worth understanding your rights before proceeding on your own.
Emergency care is another exception. If your injury requires immediate medical attention, you are generally permitted to seek emergency treatment without waiting for an authorized referral. That said, once the emergency has been addressed, the standard rules around authorized care typically apply going forward.
Changing doctors after treatment has begun is possible, but it requires either the consent of your employer and their insurer or an order from the Virginia Workers’ Compensation Commission. Simply deciding to switch providers without following this process can put your benefits at risk.
Why the Choice of Doctor Matters for Your Claim
Once you begin treating with an authorized treating physician and you have chosen that physician from the panel or accepted the referral from the workers’insurance carrier, then you are generally unable to change treating physicians. It is very difficult to change physicians after you have begun treatment with a particular doctor or medical provider.
The medical record your authorized doctor creates often becomes the foundation of your workers’ compensation claim. Diagnoses, treatment plans, and work restrictions documented by your treating physician carry significant weight in determining what benefits you are entitled to receive.
An authorized doctor who thoroughly documents the connection between your condition and your workplace injury helps establish the medical evidence your claim depends on. Without complete medical records, or if treatment is scattered across multiple unauthorized providers, the insurer may challenge the validity or extent of your claim.
Following your authorized doctor’s treatment recommendations is also important. Gaps in treatment or failure to comply with prescribed care can be used to argue that your injury is not as serious as claimed, or that you are no longer entitled to certain benefits.
Common Pitfalls to Avoid
Treating outside the authorized system generally means those medical expenses would not be covered by the workers’ compensation insurance carrier.
It is important to clearly communicate with your treating physician or medical provider that your visit is related to a workers’ compensation claim. You must describe the accident and make it clear that it happened while on the job.
When It Makes Sense to Speak with an Attorney
Questions about medical treatment are among the most common issues that arise in Virginia workers’ compensation claims. If you are unsure whether a provider is authorized, if you want to change doctors and do not know how to request approval, or if your employer has denied coverage for treatment, speaking with an experienced workers’ compensation attorney can help you understand where you stand.
An attorney can also help if you believe your authorized doctor is not providing appropriate care or is underreporting the severity of your condition. There are formal options available through the Virginia Workers’ Compensation Commission, and an attorney familiar with the process can help you pursue them effectively.
If you have questions about your workers’ compensation claim or need guidance on medical treatment issues, you can contact Inman & Strickler Attorneys at Law at (757) 486-7055 to discuss your situation.