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work comp doctors

Is my work injury eligible for future medical treatment?

 

Future medical treatment is only considered when an injured worker has sustained permanent injuries from the work accident.

Future Medical Treatment

A doctor who has treated the injured worker will need to state very specifically the type of treatment required, period of time treatment will be needed, and cost of the future treatment. Then, the Board will consider these things in light of their effect on the injured worker’s impairment.

If the injured worker is awarded future treatment, it will be for the sole purpose of limiting of reducing his or her extent of impairment. This does not mean, however, that an injured worker who is left with any degree of impairment from his or her work injury will automatically be awarded future medical treatment by the Board.

Future medical treatment may also be awarded in occupational disease cases and in permanent total disability cases.

How long will you receive medical treatment for your worker’s compensation claim?

You will receive medical treatment until you are released from the doctor at maximum medical improvement, which basically means your injury is as good as it will get and will not significantly improve with more treatment.

workers comp indiana

From this point forward, you are free to treat with a doctor on your own, but you will have to pay for this treatment. Exceptions apply to those workers who qualify for permanent total disability, or who are eligible for future medical benefits.

Can I change doctors if I don’t like the one the insurance carrier is sending me to for my work injury?

 

Not if you want to keep your benefits. Generally speaking, disliking a doctor is not a valid reason for not going to the insurance carrier’s doctor.

workers compensation

Refusing to accept the medical services that the worker’s compensation insurance carrier provides to you could lead to your worker’s compensation benefits being suspended. In most cases, you must continue treating with their doctor(s) if you want all of your medical treatment paid for, until you are released at a maximum medical improvement. There are only a few exceptions to this rule:

1. In an emergency situation

It must be a true emergency, such as complications after a surgery which arise when the doctor’s office is closed. Thereafter, the injured worker will have to return to the insurance carrier’s doctor.

2. If the injured worker is not provided with medical care by the employer or the employer’s worker’s compensation insurance carrier in accordance with the Act

For instance, two specialists selected by the worker’s compensation insurance carrier advise that an injured employee needs surgery promptly, but the insurance carrier refuses to authorize it.

3. “Because of any other good reason” [cited from IC § 223-3-4 (d)].

Please note that this is not clearly defined, so it is left to the Board’s discretion to determine what qualifies for this exception.

For example, you have a surgical procedure performed at your own expense, and result of which is significant improvement to your work injury. For instance, you could only do sit down work before the surgery, but after the surgery you can stand and work up to six hours a day. In this scenario, the Board may find such treatment to have been “reasonable and necessary,” thus falling under this exception.

In any of these situations, if possible, you should seek prior medical approval from the insurance carrier before obtaining treatment on your own.