Changing doctors in your workers compensation case can be complicated.
“Once an injured Virginia worker has established treatment with an authorized treating doctor, that physician gets to call the shots and have their opinions given great weight. If an injured worker then sees a different doctor without a referral or permission from the workers comp insurance company, then the patient may end up having to pay the bill,” notes Herndon Virginia workplace accident lawyer Doug Landau.
In a case handled by friends of lawyer Landau—a disabled employee who continued to suffer pain in her knee from a workplace accident and who was released from treatment by the first doctor she saw–the Virginia Court of Appeals ruled that she was entitled to change doctors. The court further ruled that she was permitted to obtain additional diagnosis and treatment from a board-certified orthopedic specialist. The name of the case is Miller Oil Co. v. Freeman
The employer asserted that the claimant did not meet her burden to show that the circumstances warranted a change in treating physician. A death of a doctor, closing of a practice, or other similar reasons, comes up in long-term, permanent injury cases. In this case, the initial treating doctor was still practicing in the area. In addition to acknowledging that the claimant’s continued complaints of pain were credible, the treating doctor “twice concluded that the claimant’s condition had resolved and released her from his care.” The Virginia Workers Compensation Commission further recognized that the doctor gave the claimant a “differing diagnosis and a plan of treatment.” The appeals court found credible evidence to support the Commission’s finding that inadequate treatment was being rendered, treatment was needed by a specialist in a particular field and was not being provided, and that there was an unexplained lack of progress in the improvement of the claimant’s health condition.
“This decision gives a good road map to what the courts will look for to determine if an injured worker can switch doctors mid-stream,” adds lawyer Landau. Also important to this decision was the testimony. The doctor’s testimony, taken in conjunction with the claimant’s testimony about her continuing pain (which the Workers Comp Commission specifically found to be credible), was sufficient to support the VWC’s determination that the claimant suffered a work-related injury and treatment of that injury necessitated a change in medical provider. Also, the second doctor, unlike the initial, authorized treating physician, is a board-certified orthopedic specialist. The Virginia Court of Appeals found the Workers Compensation Commission did not err by resolving the differences in opinion in the claimant’s favor.
If you or someone you care about has been injured at work, and there are questions about medical treatment, bills, legal protection, and how best to proceed, please call us at (703)-796-9555 or contact us via email here.