Medical Benefits and Choosing a Doctor

Changes to Illinois workers compensation laws that were enacted in 2011 now limit injured workers’ choices when it comes to seeking medical treatment and choosing a doctor after sustaining a workplace injury. Under the provisions of the new amendments to Illinois workers compensation laws, injured workers have to either:

• Choose a doctor in their employer’s preferred provider network, which includes a list of doctors chosen by the employer. Although Illinois employers are not required to set up a preferred provider network from which their injured employees can choose doctors, the changes to workers compensation laws have enacted special incentives (including saving money) for both employers and insurance companies to have such a network (and consequently be contracted with a limited group of specific doctors.
• Opt out of the employer’s preferred provide network, in which case the injured worker will only have one choice of doctor he can go to for treatment. While any doctors that the initially chosen doctor refers the injured worker to will be considered to be part of the injured worker’s single choice, the limitation of having one choice can be especially problematic if the injured worker is referred to a doctor that is not a good match for him (in other words, injured workers will not have the privilege of getting a second opinion if they are referred to a specialist that doesn’t seem to be a good match and is recommending extreme treatments).

Possible Exceptions to Choosing Doctors and Seeking Medical Care

While the recent changes to Illinois workers compensation laws have significantly limited injured workers choices when it comes to seeking medical care for their injuries, there are some exceptions that may apply. Injured workers can argue for exceptions from their employer’s preferred provider network and the one-choice rule for opting out of this network if they can:

• Prove that they need treatment from a specialist that is not within the preferred provider network
• Demonstrate that the doctors in the preferred provider network are not administering proper or adequate care for the work-related injuries.

At the law firm of Hassakis & Hassakis, P.C., our experienced Mount Vernon workers compensation lawyers have been providing client-centered representation to our Southern Illinois clients since 1950. Our trusted attorneys focus on our clients’ needs, and we do everything we can to help them get the maximum possible compensation for their workplace injuries so they can focus on recovery and moving on with their life. If you or a loved one has sustained any type of injury while working, contact us by calling (800)-553-3125 for a free, thorough assessment of your case, along with professional advice regarding the best manner in which to move forward.