medical treatment

The insurance company will generally make strategic decisions to save themselves money.

In Missouri, workers’ compensation laws are designed to bring some comfort to workers who might get injured or sick on the job. They state that should workers have a medical need directly resulting from their work, then the costs will be fully covered by these benefits.

However, Missouri also has a rule that many other states do not; it allows the employer to choose the doctor who will be treating you. In a best-case scenario, this would not pose much of a problem, and the workers would continue their treatment until they are ready to resume their work. However, what happens when the workers want a second opinion?

Getting a Second Opinion

Even if the law says your employer has the right to choose the doctor, you should know that in most cases this choice is given to the insurance company which ultimately pays the costs of your medical treatment. For your boss, it’s one less hassle to worry about. For the insurance company, it’s a strategic move that allows them to control, at least in part, how their money is spent.

Though they will choose the doctor, the insurance company cannot suggest what kind of treatment or medical interventions you should get, nor can they try to persuade the doctor in altering their medical advice based on what’s more cost-effective for them. If you suspect the insurance company gets a say in your treatment this should be discussed with your attorney as soon as possible.

However, even if the insurance company is doing things by the book, it doesn’t mean you’re in for smooth sailing. For instance, if you do not agree with the diagnosis or treatment plan the doctor decided, in normal circumstances you’d get a second opinion. However, to have that reimbursed by the insurance company (under workers comp benefits), you first need their approval.

And frankly speaking, it’s very unlikely they will approve this move, as it can be seen as an unnecessary extra cost.

You’re Not Without Options

If you go at it alone, you are going to have a tough time getting anywhere with the insurance company. However, you should consider hiring a St. Louis workers compensation attorney for additional help. With a strong case, you may be able to convince the insurance company of approving a second opinion, but even if you don’t, there is another option.

The Missouri Workers Comp Division routinely weighs in on cases where there is an issue, such as not agreeing with the recommended treatment. With the help of a lawyer, you can take your case in front of an administrative judge. The judge, upon reviewing the evidence, can then order a second medical opinion which you do not have to pay for. Additionally, you won’t face any repercussions for this either, as you are well within your right to do so.

If you have been injured on the job in the state of Missouri, give us a call 24/7 at (314) 361-4300 to learn more about your legal options.

Neither the insurance company nor the employer can choose how you are being treated or what’s done in order to help you get better.

When you file a workers comp claim, you are essentially asking for your medical costs caused by a work injury or illness to be covered in addition to other compensation you may be entitled to. In Missouri, the employer has the legal right to choose the doctor who will administer said treatment, which can often bring forward a set of issues.

What Does the Law Say?

Legally, your employer has the right to choose the doctor who will be treating you if you file a workers compensation claim. They usually transfer this right to the insurance company that will ultimately make the reimbursements because the company frequently collaborates with doctors.

As a result, if you seek treatment for your work injuries from a different doctor, you risk missing out on workers compensation benefits. However, if you went to your own doctor to get diagnosed, it is possible to get the costs reimbursed if you argue you were not aware of your work-illness at the time – you were just visiting your doctor for a routine check-up.

You may ask your employer to allow you to continue seeing your doctor, and if they agree, the insurance company must comply, unless the employer has legally transferred their right to choose the doctor to the company (some may ask for it in writing, while others may not). The insurance company will most likely not be very keen to allow you to seek a doctor of your choice, because they’d prefer you go to the one they have a relationship with.

Why Is That Important?

Because the insurance company knows the doctor who is treating you, it can be much easier for them to get information about your medical improvements, either directly from the doctor, or “spies” like nurses or other hospital staff. As a result, they can be one step ahead, and move to stop your benefits when you’re showing improvement.

However, neither the insurance company nor the employer can choose how you are being treated or what’s done in order to help you get better. That remains the decision of the doctor, who must choose the best course of action for you regardless of the insurance company’s wishes.

I Suspect I’m Not Getting the Best Treatment

If you think the insurance company may have too much of a say in your treatment, you have some options for fighting back. One possible solution is requesting the help of the Dispute Management Unit, which will act as a mediator and try to make sure each party is heard.

Another option is to sue the insurance company, though this is really only an option if you have proof they are overstepping their bounds and deciding your treatment.

Speak With a St. Louis Work Injury Lawyer

If you think your insurance company if influencing your treatment, you can fight back. Get in touch with a St. Louis workers comp lawyer to see what your options are. Give us a call 24/7 at (314) 361-4300.

Your doctor will generally recommend a less invasive course of action at first, however surgery may be recommended if it is the best course of action.

Workers compensation cases can be very difficult. Most workers believe that once a claim gets approved by the employer and the insurance company that the battle is won, but reality shows this is not always the case.

In Missouri, your employer has the right to choose the doctor that will be administering your treatment in a workers comp case, which is often left at the hands of the insurance company. This can lead to many issues and concerns about whether you are getting the right form of treatment.

Case in point, your workers’ comp doctor recommends surgery. What should you do?

Understanding Your Health Issues

Surgery is rarely the first choice for treatment. Most often, it is a last case resort to get immediate intervention and fix a medical problem. For instance, if in the work accident you got punctured by an object, then surgery may be required immediately. It’s also possible for additional surgeries to be needed later on, if there are complications, for instance.

Your doctor will generally recommend less invasive courses of action at first, but if at one point they consider it the best option, surgery might be brought to the table. The insurance company may not have a say in your treatment, but it does need to know about your medical procedures and approve them for compensation. In their eyes, it prevents workers from taking advantage of these benefits to cover additional health issues that have nothing to do with the workplace injury.

Workers’ compensation benefits stop when you reach the maximum recovery, meaning you reasonably cannot get better, even if your health condition after workers comp isn’t the same as before the accident. Sometimes, workers will require additional medical interventions, like surgeries, after these benefits stop. In this case, can the intervention still be covered by your employer?

Do You Have a Settlement?

If you have accepted a settlement from the insurance company, this generally means that you agree not to get reimbursed for future medical costs later on, even if it’s clear they are still part of your work injury. If you’ve already accepted a settlement, and this measure is clearly defined, then, unfortunately, there is not much you can do. In some cases, your health insurance may cover the costs of your surgery, though some health plans explicitly exclude work-related injuries.

If you know you’ll be having additional medical costs, they can be added to the settlement, and then you can rest assured that all future costs of treatment will be covered, even if you technically settled your case. If the insurance company offers a settlement you should discuss it with an experienced work injury lawyer before accpeting it.

Workers’ compensation laws are complex, so you should generally work closely with a St. Louis work injury lawyer to make sure your legal right to workers compensation is protected right from the start of your claim. Give us a call 24/7 at (314) 361-4300 for a FREE case evaluation.

Companies are required to provide employees with proper medical care and treatment after a work-related injury.

A work injury can take a toll on the victim’s life. Not being able to sustain oneself and provide for the family can make you feel powerless. Depending on the seriousness of your injuries, you may expect a long time of recovery, expensive visits to hospitals and doctors, therapy, special items around your house, medication, and so on.

The good news is that the law in Missouri requires companies with more than five employees to carry workers compensation insurance exactly for these situations. You have to follow a few legal steps to be able to access it, such as filing an official report and getting checked by a doctor. It is also a good idea to contact a St. Louis workers compensation lawyer for help.

But can you go to a doctor of your choice for the medical evaluation? Can you, for example, go to a high school friend that will do you a favor since you are out of money? Or can you go to a resident that just finished medical school?

Let’s see what the limitations and indications that you need to take into account when choosing a doctor to evaluate your work-related injuries.

So, Can You Choose Your Own Doctor?

There is really no straight answer to this question, as it depends a lot on the state you work and live in. Each state has its own regulations about workers compensation claims conditions, and you need to follow them precisely to win your compensation.

In Missouri, for example, you can’t choose the doctor yourself. Instead, your employer or their insurance company will propose a doctor or a medical network you can limit yourself to. In other states, this limitation only applies to recurrent visits. As such, you are free to be seen by the doctor you choose yourself for your first evaluation. If your work-related injuries required emergency care, then those that review your case will keep this aspect in mind.  

You also want to first check in with your doctor, to see if they treat work-related injuries. Not all doctors will choose to work with injured workers. Different rules apply to how the evaluation takes place, how the treatment is paid for, and so on.

What If the Doctor Chosen by the Company Will Favor Them?

One way to avoid such conflicts of interests is by requesting a second opinion, if the doctor you have seen does not seem to agree with you on the extent of your injuries or if you just don’t like them, for whatever reason.

What If I Don’t Like My Doctor?

As mentioned already, according to the Missouri state law, you generally can’t choose your own doctor after a work injury. That’s because companies are required to provide employees with proper medical care and treatment.

If, however, you are unsatisfied with what your employer has to offer, you can change your doctor, but you will generally have to support all the costs.

Workers’ compensation is a government-sanctioned system, and as a result, has strict rules.

When you are injured in a work-related accident, you need to do everything you can to get better. Sometimes, this leads to people exploring alternative forms of medicine. Doing so is not a straightforward process though, as some treatment options are covered, and others are not.

Types of Alternative Medicine

Though there are hundreds of forms of alternative medicine, the following are the ones that are most commonly used.

Acupuncture – This practice involves inserting pins into the outermost layer of your skin. Some patients report that it helps with pain management and a variety of mental issues like stress and depression.

Homeopathy – The most controversial practice on this list is homeopathy, which is generally considered an outdated and dangerous form of medicine. It uses a “like treats like” philosophy, which is best explained as using diluted poison ivy to treat a rash. As you might imagine, this practice has a poor reputation in the medical field.

Massage – Though it is considered alternative medicine, massage has been proven to benefit those with injuries. For this reason, it is often used in physical therapy and injury management.

Why People Choose Them

After sustaining a severe injury, people are often open to any treatment that could help them. Additionally, they are frequently disillusioned with the care they get from their doctor. The result is looking into alternative options, which are commonly found on the internet or through a personal reference.

Will They Be Covered?

The general rule of thumb is that these forms of medicine are not covered. Workers’ compensation is a government-sanctioned system, and as a result, has strict rules. The result is that you must use scientifically proven medicines over alternative options if you want those treatments paid for.

Exceptions to the Rule

The exceptions to this rule come from the vagueness of the term “alternative medicine.” To explain this, let’s take two examples from the three that we listed above. First, homeopathy. This treatment has no scientific backing, and as a result, would not be covered. On the other hand, many consider massage an alternative medicine too, even though it has legitimate medical data proving its effectiveness. For this reason, you may be able to include regular massages in your coverage.

The law is quite simple when you deal in areas of black and white, but when you explore areas that are somewhere in the middle, it gets significantly more complicated. This applies to deciding whether certain medical treatments are worthy of workers’ compensation support. When you hire a lawyer to assist you, they will answer your questions, recommend whether or not you should pursue compensation for a treatment method, and fight for you if you decide to do so. If you ever want to look into alternative treatment options but aren’t sure if they’ll be paid for, you should first speak with an experienced St. Louis workers compensation attorney.

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