Who Wins?
In this article, I want to talk about what should you do if the company doctor says you don't need medical care or a surgery or a procedure, but my personal doctor does. How do we fix that tie breaker? How do we make sure that you the medical care that you need? So, what do you do when your doctor says you need the surgery? You think you need a surgery, but the company doctor says you don't need the surgery. And the company doesn't want to pay for it.
Well, here's what happens. There is a lot of possibilities here and the technical thing the way it works in workers comp is, you get to pick who your doctor is. And you get to pick whose advice you want to follow. You have every right in the world to go forward with the surgery, if you trust your doctor and you believe in your doctor.
You Can Pick Who Your Doctor Will Be
That's the first thing for you to know, just because the company or the insurance company, the workers comp insurance company, doesn't want to pay for it. Sometimes Hired Gun doctor doesn't want to pay for it, doesn't mean you don't get taken care of. But the first thing I tell people is, if you have health insurance, then you can just get the surgery and charge it through your health insurance. And then we'll fight the case and later on make them pay the insurance pay back for the money that they paid.
That's one way and it's often the best solution because it allows you to get the medical care you need with no delay. But what if you don't have health insurance? What if your treating doctor doesn't accept your insurance?
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Talk To Your Doctor
The second option is to talk to your doctor about whether he or she is willing to give you the care, give you the medical treatment, and wait for your lawyer to fight it out in court. If some doctors are willing to do that, and other doctors aren't, if you have a doctor who's willing to do that, then that's awesome.
You get the medical care you need right away. Now, some doctors are nervous about that and that's why I tell my clients, I'm always happy to talk to their doctors in those situations to assure the doctor that we plan on fighting the case all the way.
What To Do If Your Doctor Don't Want To Do It?
Well, one thing you can consider doing is switching doctors. Another thing you can consider doing is letting your lawyer know that and then your lawyer can go to court on what's called a 19B motion. In Illinois and in other states, the rules are numbered different. But you can go to the court on an emergency basis and force the company to pay. But that takes time, I usually tell people that it takes about six weeks to get in front of a judge. On an emergency basis, in workers comp at least that's the case in Illinois could be longer and could be quicker.
But the emergency process in workers comp is unfortunately not very quick. Here's something that I will sometimes do, if I feel very strongly about the medicine in your case, I will call the other attorney or I'll call the insurance company and I'll tell them,
"Look, your guy says my guy doesn't need it. My doctor says he does, my client really needs it. He really wants to get better or she really wants to get better and get back to work. So how about this? How about you and I agree to a tie-breaking doctor and we let the tie-breaking doctor tell us their opinion?"
And then, we can agree on a doctor. They will probably suggest a doctor that they hire all the time, and this is where having an experienced workers comp lawyer on your side makes a big difference. That's what it's going to end up coming down to now what do you do if the tie-breaking doctor doesn't think you need the surgery or doesn't think it's related to work.
Usually, what happens there is the tiebreaker doctor will say, "Okay, I think surgery is too soon. How about he does another six weeks of therapy? How about we try this other treatment?" And I will tell you, unless the tie-breaking doctor is a real jerk, as long as my client is willing to follow their instructions and get some additional therapy, when they return to the doctor and things haven't gotten better with the injection or the additional therapy. The additional therapy usually, the tie-breaking doctor says,
"Yes, they need the surgery."
So, it's a longer process it's like an end around process to eventually get you to where you need to go. Which is getting you the medical care you need. Those are the strategies that I use when one of my workers comp clients has a problem like that. If you're a loved one needs a lawyer or needs a consultation or has a question please feel free to give me a call. Please let me know and call me at 312-500 4500 you can call that phone number anytime night or day and I'd be happy to answer your questions or if you have a case and need representation, I'm happy to help you in that regard too.
