Company Doctor Says No, Personal Doctor Says Yes
I want to talk to you about: What should I do if the company doctor says I don't need medical care or a surgery or a procedure but my personal doctor does? Who wins? How do we fix that tie breaker? How do we make sure that you get the medical care you need?
I just got off the phone with a guy who had that problem. 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's a lot of possibilities here.
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Your Right To Pick A Doctor
So 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. That's the first thing for you to know. Just because the company or the workers comp insurance company doesn't want to pay for it or their hired gun doctor doesn't want to pay for it, doesn't mean you don't get taken care of.
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. Then we'll fight the case and later on make them pay the insurance company back the money that they paid. So that's one way. It's often the best solution, because it allows you to get the medical care you need with no delay.
Talk To Your Doctor
What if you don't have health insurance? What if your treating doctor doesn't accept your insurance? Well 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. Some doctors are willing to do that and other doctors aren't. If you have a doctor who's willing to do that, that's awesome. You get the medical care you need right away. Some doctors are nervous about that. 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.
19B Motion
But what do you do if your doctor won't do it? 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. That's in Illinois, 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 now. 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, could be quicker. But the emergency process in workers comp is unfortunately not very quick.
A Tie-Breaking Doctor
But 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 gonna 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?"
A Long Process
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, usually the tie-breaking doctor says "yep they need the surgery". 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.
