Choice of Doctor
Author: Eley Law Firm
Employers have the right to select the treating physician for an employee who is injured at work.
Main DigestIn Colorado, employers have the right to select the treating physician (referred to as the "authorized treating physician") for an employee who is injured at work. This is known as the first right of selection. The employer's right to selection is triggered once the employer learns of the on-the-job injury.
First Right of Selection
In Colorado, employers have the right to select the treating physician (referred to as the "authorized treating physician") for an employee who is injured at work. This is known as the first right of selection. The employer's right to selection is triggered once the employer learns of the on-the-job injury.
Once the employer receives notice of the injury, the employer must then provide the employee with a list of at least two physicians or two corporate medical providers (for example, a physician practice group). The employee then must select a treating physician from the list. Employees who do not see an authorized treating physician are responsible for the full costs of treatment of an unauthorized physician.
The employer's first right of selection will be waived if:
"The employer does not offer the services of a physician or corporate medical practice at the time the employer is notified of the employee's injury
"The physician authorized by the employer refuses to accept the employee as a patient or refuses to offer treatment to the employee for non-medical reasons.
In either situation, the employee's secondary rights to selection are triggered and the employee may choose a doctor of his or her preference for treatment. The employer's insurance company will be responsible for the costs of treatment.
The employer does not lose its rights to selection of the treating physician just because the employee fails to notify the employer immediately of the injury. The employer's rights are triggered once it receives notice of the injury, even if this is days after the injury occurred.
In situations requiring emergency medical treatment, injured employees are not required to notify their employers of the injury prior to seeking treatment. Rather, after the emergency has passed, the employee then should notify the employer of the injury. At that time, the employer has the right to select the treating physician and should provide the employee with the list of authorized options.
It is important to note that some people are under the impression that their own health insurer or another insurance policy (such as a car insurance policy) will pay for treatment that their employer's insurance company will not cover. This may not be true. Many insurance policies have a disclaimer stating they will not pay for treatment for workplace injuries, leaving the injured worker with the responsibility to pay for the costs of treatment not covered by their employer's insurer.
The general rule is that once an injured employee sees the employer-authorized physician, the employee only can see an unauthorized doctor if he or she pays for the expenses out-of-pocket.
However, an employee may be able to change doctors. The employee may submit a written request for permission to see his or her own physician to the insurance company. The request must be for medical treatment, and not just an evaluation. Also, the request must provide the name of the current authorized treating physician and the name of the requested new physician. The insurance company is under no obligation to grant the request. However, if the insurance company does not respond to the request within 20 days of the date the letter was mailed, then the insurer waives its rights to object and the employee can proceed with his or her own doctor, at the insurance company's expense.
Colorado law also provides a one-time change in the authorized treating physician. However, employees are not allowed to choose their own physician. The change only can be to another provider on the employer's list of authorized physicians. The transfer request can be denied if it poses a health or safety risk to the employee. The request must be made within 90 days of the injury and before the employee reaches maximum medical improvement. The notice must be in writing on the approved form by the Division of Workers' Compensation and directed to the insurance company or the employer's authorized representative and the current authorized treating physician. The notice must be delivered by hand or mail to the employer, who then will provide notice to the insurance company (or authorized representative) and the current treating physician.
Employees wishing to change physicians can take an informal route as well. The employee's attorney may be able to speak with the insurance adjuster and request a change of physician. After explaining the reasons for the employee's desire to change, the insurance adjuster may agree to do so, saving the employee time and expense.
Reference: Article provided by the Eley Law Firm. Please visit our Web site at www.eleylawfirm.com.
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