Under Texas workers' comp, you have to see an approved doctor.
An unpopular rule in Texas workers' comp law is that injured employees must see an "approved doctor." If you have been injured while working, your workers' compensation coverage pays for your medical care. But the insurance carrier representing your employer will sometimes attempt to distort what the law states about this medical coverage in an effort to manipulate the potential cost of your medical care.
This article will discuss your medical care options as covered under the Texas Labor Code and how your employer may attempt to control your care or create bias.
Questions Answered on This Page:
- Do I have to use a specific doctor to qualify for workers' compensation?
- What is an "approved doctor" mentioned in the workers' compensation laws?
- Can I use my own doctor if I've been injured on the job?
The Relevant Statutes:
Sec. 408.022. SELECTION OF DOCTOR. (a) Except in an emergency, the division shall require an employee to receive medical treatment from a doctor chosen from a list of doctors approved by the commissioner. A doctor may perform only those procedures that are within the scope of the practice for which the doctor is licensed. The employee is entitled to the employee's initial choice of a doctor from the division's list.
This law essentially says that you are not free to choose your own doctor if you're hurt on the job and your employer has workers' comp coverage. The workers' comp board has compiled a list of doctors that meet their criteria. You may only be seen by a doctor on that list under most circumstances.
The statute makes an exception for emergency care. Obviously, it would cost people their lives if they couldn't simply be transported to the nearest hospital, and instead had to find a workers' comp approved hospital. But in all other situations, injured workers are at the mercy of the workers' comp board, with respect to picking their physician.
Common Questions and Concerns:
What if you are not satisfied with your original selected physician? Can you change doctors? Will this switch be covered by workers' compensation? Again, we can turn to the statute for a clear answer.
- (b) If an employee is dissatisfied with the initial choice of a doctor from the division's list, the employee may notify the division and request authority to select an alternate doctor. The notification may be by telephone when a medical necessity exists for immediate change.
- (c) The commissioner shall prescribe criteria to be used by the division in granting the employee authority to select an alternate doctor. The criteria may include:
- whether treatment by the current doctor is medically inappropriate;
- the professional reputation of the doctor;
- whether the employee is receiving appropriate medical care to reach maximum medical improvement; and
- whether a conflict exists between the employee and the doctor to the extent that the doctor-patient relationship is jeopardized or impaired.
- (d) A change of doctor may not be made to secure a new impairment rating or medical report.
- (e) For purposes of this section, the following is not a selection of an alternate doctor:
- a referral made by the doctor chosen by the employee if the referral is medically reasonable and necessary;
- the receipt of services ancillary to surgery;
- the obtaining of a second or subsequent opinion only on the appropriateness of the diagnosis of treatment;
- the selection of a doctor because the original doctor:
- retires; or
- becomes unavailable or unable to provide medical care to the employee; or
- a change of doctors required because of a change of residence of the employee.
- (f) This section does not apply to requirements regarding the selection o a doctor under a workers' compensation health care network established under Chapter 1305, Insurance Code, except as provided by that chapter.
Section 408.022 goes on to outline the restrictions for changing physicians. While it is allowed, you cannot simply change doctors without a legitimate reason. For example, you cannot simply change doctors because you do not like your current one. You must have a valid reason for requesting the change and the commissioner may establish standards for making this change. For instance, if your doctor was unprofessional in any manner, you will probably have a valid reason for requesting the change and the state would probably approve it.
This section also addresses the issue of conflict of interest, which we previously mentioned. Sometimes employers will want to have their approved doctors oversee your medical treatment; however, doctors associated with your employer can be biased and unable to provide adequate treatment that is unprejudiced. In this situation, the doctor may not have your best interest at heart and, therefore, this would be a valid reason to change physicians.
Give Grossman Law Offices a Call:
In short, if you have been injured and need to select a physician for your workers' compensation covered medical treatment, you do not have to choose a physician who is approved by your employer. If you believe that your employer is trying to unfairly manipulate or interfere with your medical care, contact Grossman Law Offices at (855) 326-0000.
Other articles about worker's compensation that may be helpful to you: