Can I see my own doctor for a work-related injury?

industria meccanicaAccording to the Illinois Workers’ Compensation Commission, workers’ compensation benefits represent a valuable safety net for Illinois workers who incur injuries on the job. However, for many such beneficiaries, having the freedom to choose who provides the medical care they need is also important. Under Illinois law, employees are able to see their own doctor for a work-related injury, but provisions in the law specify the constraints to this privilege.

Before the Illinois Workers’ Compensation Act was revised in 2011, employees with work-related injuries were entitled to select up to two medical providers of their choice outside of their employers’ chosen medical provider. While there are still cases in which the same entitlement exists, revisions to the law include limiting conditions for physician choice.

Preferred provider programs limit out-of-network options

Employers are now entitled to form what the new legislation calls a Panel of Physicians, which represents a network of preferred providers. If approved by the Illinois Workers’ Compensation Commission, employers’ preferred provider programs limit injured employees’ choice of physicians.

If employers do not have a Panel of Physicians in place, Illinois law preserves the legacy right for employees to select up to two medical providers of their choice. In this case, the law specifies that the following situations do not generally constitute one of the two available choices:

  • Emergency room visits
  • First aid care
  • Consultations with on-site company physicians

If employers have a Panel of Physicians in place, employees may choose to initially receive medical care through a participating network provider, after which the option to choose a non-participating network provider is available. Alternatively, employees may choose to initially receive medical care through a non-participating network provider, which precludes them from another choice of a provider.

Starting in-network may be advantageous

After experiencing a workplace accident, many employees may be inclined to immediately opt for a physician with whom they are familiar and comfortable. Notwithstanding this understandable response, the revised legislation penalizes it. Specifically, foregoing a participating network provider removes the option of receiving a second opinion. For this reason, injured Illinois workers may find advantage in first exhausting the right to receive employer-covered care through a preferred provider program.

On a final note, an employee-friendly feature of Illinois workers’ compensation law is the ability to receive coverage for the entire chain of referred care that originated with an eligible provider. To illustrate, if one of the originally selected physicians referred an employee to a specialist, whom, in turn, referred the employee to another specialist, and so on, the employer would be responsible for covering all care received through that chain of referrals.