Choosing your own Physician in Wisconsin Worker’s Compensation

In the Wisconsin Worker’s Compensation system, the injured worker has the right to choose his or her treating physician. This right is outlined in Wisconsin Statutes Section 102.42(2)(a), which states, in part: “…the employer shall offer to the injured employee his or her choice of any physician, chiropractor, psychologist, dentist, physician assistant, advanced nurse prescriber, or podiatrist licensed to practice…”

However, a frequent scenario that injured workers face is an employer and/or insurance company that attempts to direct an injured worker’s medical care and treatment. Commonly, injured workers will be told where to go and whom to see. Even though an employer and/or insurance carrier may offer advice regarding what medical facilities to go to and which doctors to see, the injured worker in Wisconsin Worker’s Compensation still has the right to forego that advice and choose his or her own treating practitioner. This right, though, comes with important provisions to remember.

First, there is a two-choice limit on how many treating practitioners an injured worker may choose; however, this two-choice limit only applies when doctors are in separate chains of referrals. For example, let’s say an injured worker first sought treatment from his primary care physician, was then referred to an orthopedic specialist, and was then referred to a pain management specialist. Since each doctor had a referral, this is considered one chain of referrals and, thus, only counts as one choice. But, if the injured worker in the previous example finds a doctor on his own for a second opinion and this physician is not seen on referral from any of his previous physicians, then this counts as his second choice.

Second, it is always important to remember that even though an injured worker may choose his or her treating physician, the employer and/or worker’s compensation carrier may still deny payment for the treatment rendered based on a denial, independent medical evaluation, or the insurance may argue that the treatment was not reasonable and necessary.

Even though injured workers in Wisconsin currently have the right to choose their own treating practitioner, there are different worker’s compensation laws for other states. For example, in Texas there are networks from which an injured worker has to choose a doctor. http://www.tdi.texas.gov/WC/employee/workerresources_english.html#q5. Also, in Oklahoma the employer, not the employee, has the right to choose an injured worker’s treating practitioner. https://ok.gov/wcc/documents/5_18_16%20Guide%20for%20Injured%20Workers%20FINAL.pdf

Recently in Wisconsin, there was an effort to change an injured worker’s right to choose their own treating practitioner. Similar to Texas, this proposed change would have required injured workers to select a treating practitioner that was provided in the health benefit plan of the employer. https://docs.legis.wisconsin.gov/2015/related/proposals/ab501. This proposed change, however, was not enacted.

Since the law on this topic is constantly evolving, it is important to consult with an experienced worker’s compensation attorney if you have questions or concerns regarding your particular case.

Posted on January 18, 2017 @ 2:06 pm

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