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Facts about Workers’ Compensation Doctors and Independent Medical Exams

One of the more confusing issues for an injured worker going through a workers’ compensation claim in Texas is the requirement to see a doctor chosen from a list provided by the TX Division of Workers’ Compensation. The workers’ compensation insurer or the Division also may order an independent medical exam by a “designated doctor” selected by the insurer or division.

The workers’ compensation attorneys of Herrman & Herrman in Corpus Christi, TX, can help you pursue workers’ comp benefits after a workplace accident if they are available. We can answer questions during an initial consultation and review your claim and what benefits are available to you. The consultation is always free.

Can I Choose My Workers’ Compensation Claim Doctor?

If an employer in Texas has workers’ compensation insurance, the injured or ill worker seeking workers’ compensation benefits will be provided a list of approved physicians from which he or she may choose a doctor to see for non-emergency medical care. If the injured worker is dissatisfied with his or her initial choice, the worker may file a request in writing to see another doctor from the Workers’ Compensation program’s list.

However, you can’t request such a change just to secure a new impairment rating or medical report. You will need to present a valid reason for making the change, such as the doctor behaving unprofessionally or having a conflict of interest regarding your treatment.

In addition, the Division of Workers’ Compensation (DWC) may select a designated doctor to examine the claimant to resolve questions about an injured employee’s medical condition or resolve a dispute about a work-related injury or illness.

This examination process is known as an “independent medical exam.” The injured employee, the employee’s representative or insurance carrier, or the DWC can request an exam by a designated doctor. The DWC will determine if a designated doctor should be appointed to conduct the exam.

Is the Independent Medical Exam Obligatory?

The independent medical exam is obligatory if ordered by the DWC. Failing to undergo a worker’s compensation exam when ordered will likely lead to denial of your workers’ comp claim. Indeed, a workers’ compensation claimant must be careful to follow all orders and directions of the DWC and doctors he or she sees.

The problem is that an employer’s objective for ordering an independent medical exam is often to have their worker declared fit to return to work. The exam may lead to a declaration that the worker can assume light duty, which reduces benefit payments, or that the worker has reached maximum recovery, which may lead to a settlement that closes the claim.

You may expect to be referred for an independent medical exam if:

  • The insurance company disagrees with your treating physician’s medical opinion.
  • Your claim is becoming too expensive.
  • The insurer needs to resolve a dispute about your claim, limit your benefits or deny your claim entirely.

What Should I Avoid Doing with a Work Comp Doctor?

You must follow doctors’ orders during the course of a workers’ compensation claim. But you also must protect yourself when dealing with a doctor assigned to your claim. Your medical treatment and what you say to your workers’ comp doctor will be a part of the medical records seen by your employer’s insurance company. It is easy to make mistakes in dealing with a workers’ compensation doctor that can be used to undermine your claim.

To ensure your claim record reflects well on you, you should:

  • Seek prompt medical treatment. Seek medical care promptly after an accident and report it to your employer. Failing to seek immediate medical care after a workplace injury makes it easier to contend that you were not substantially injured.
  • Keep medical appointments. You should follow doctors’ orders for treatment, including attending all medical appointments. Otherwise, it may look like you are not trying to get better, or that you have not really been hurt. If you truly disagree with your doctor’s recommended treatment, a workers’ compensation lawyer may help you dispute it, and request an independent medical exam. Until a different medical opinion is part of the record, do as the doctor tells you.
  • Disclose medical information. When the doctor asks about your medical history and any similar injuries you have had, answer truthfully. The doctor needs this information to properly treat you. If the workers’ comp insurer discovers a prior injury that you have failed to disclose, it may be enough to claim your medical issues are due to a preexisting condition and jeopardize your workers’ comp claim.
  • Never embellish your injury. Give the doctor straightforward facts about the accident and your injury. Don’t use overly descriptive language. If later statements don’t match, it could reduce your credibility and damage your claim.
  • Avoid downplaying your injury. This is no time to be a hero. Tell your doctor you are in pain if you are and explain any physical limitations or difficulties your injury continues to cause you. The doctor will record your comments as part of the medical record. This will help ensure you are properly treated and that you are not sent back to work before you are ready to resume your job duties.
  • Return to work when ready. If you are not physically and psychologically ready to return to work after an accident, say so and explain why. The objective of workers’ compensation is to assist you until you are fit to return to work, but you must be ready or it can be detrimental to your health and more expensive if you relapse or re-injure yourself. Many employers will pressure workers to return to work before they are ready. Ask a workers’ compensation attorney for assistance.

Contact a Workers’ Compensation Attorney in Corpus Christi, TX

The Texas workers’ compensation system is a complex program with rules that do not necessarily benefit the injured worker. At Herrman & Herrman, P.L.L.C., our workplace injury lawyers in Corpus Christi, TX, pursue work-related injury claims on behalf of injured South Texas residents. Our decades of experience can guide you through a claim and help ensure you recover all of the benefits Texas law says you deserve to have.

Contact us today for a free, no-obligation discussion of your claim and the benefits you are due.