There is a common misconception that when you suffer a Wisconsin work injury, you must see your employer’s doctor or one they recommend. However, under the Wisconsin Worker’s Compensation Act, injured workers in Wisconsin have the right to choose their own doctor. Choosing a doctor you trust to treat you for a work-related injury is important to help you get the best medical care and optimal outcomes.
Note that employers and worker’s compensation insurance companies often suggest, or even instruct, that injured workers see a particular clinic or doctor. It may be phrased as “You should go here,” or “We want you to go here,” or “You need to go here.” Wisconsin worker’s compensation claimants have the right to respond, “No. I am going to see the doctor I choose.” It is against the law for an employer or worker’s compensation carrier to refuse to pay for treatment at a clinic or doctor you choose following a Wisconsin work injury solely on the basis that you chose that doctor or clinic, except for emergency treatment immediately following an injury. Employers can direct care to a particular clinic or doctor for emergency treatment if they wish, and the injured worker has a choice thereafter. However, very importantly, also note the two-choice limit discussed below.
Kingree Law represents people in Wisconsin who have suffered serious workplace injuries - single incident or occurring over time - that have resulted in temporary or permanent wage loss, or permanent disability. Contact us today to schedule an appointment to discuss your situation and how he can help you recover the benefits you deserve. We can help if your claim has been denied. Even if your claim has not yet been denied, there may be important benefits that are not conceded by the worker’s compensation carrier without significant, diligent effort to build a case for those benefits.
Unlike a doctor who sees you once for a single evaluation, when a workplace accident causes serious injuries, your treating doctors will provide care, referrals to other doctors, and monitor your medical condition over time. It is important to select a doctor you trust.
In a worker’s compensation claim, your treating physician will make important decisions that could impact your recovery and your worker’s compensation benefits, including:
With so much at stake, it is important to choose a doctor you know will have your best interests in mind.
Under Wisconsin law, an injured worker has the right to choose their own treating doctor, subject to some limitations. Wisconsin Statutes Section 102.42(2)(a) states, “[T]he 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…” But sometimes, the injured worker’s employer or their insurance carrier tries to direct the injured worker’s medical care and treatment, telling them where to go and who to see.
While an injured worker’s employer and/or their insurance company can offer advice about where the injured worker should seek treatment, the injured worker has the right to forego that advice and seek their own medical provider. However, exercising this right comes with some important provisions to consider.
Wisconsin worker’s compensation law recognizes that when an injured employee does not have confidence in their doctor, recovery may be delayed. Therefore, if the injured worker is not satisfied with the first doctor they select, they have the right to choose a second doctor. The injured worker must notify their employer of the second choice of doctor, and the employer may not object to it. However, if the injured worker wishes to select a third doctor, any additional changes must be made by mutual agreement between the employer, the injured worker, and the employer’s insurance carrier.
The two-choice limit only applies within a single chain of referrals. For example, suppose an injured worker is seen by their primary care physician, who refers them to an orthopedic specialist, who then refers them to a pain management specialist. Because each doctor came with a referral, this is considered a single chain of referrals and only counts as one choice. But if the injured worker found a doctor on his or her own and this doctor was not seen through a referral from a treating physician, that doctor counts as the injured worker’s second choice. All referrals provided by the second choice doctor count as the second choice.
Even though you can choose your own doctor in a Wisconsin worker’s comp case, your employer and/or their worker’s compensation carrier may not cover the cost of treatment - or any other worker’s compensation benefits - if your claim is denied by a factual, legal, or medical defense. Examples of medical defenses include that your own doctors do not discuss the work injury in their medical records or do not indicate that the current condition is work-related, your own doctors do not indicate that a particular treatment is necessary, or when the worker’s compensation carrier hires a defense doctor (IME or Medical Record Review) to dispute work-relatedness.
When choosing a doctor for your Wisconsin worker’s comp case, it is important to select a clinic or physician who has experience treating injured workers. Doctors who are unfamiliar with the claims process may fail to properly document work-relatedness, which could make it more difficult for you to obtain the benefits you deserve.
If you see your primary care physician after a workplace accident, be sure to inform them that you were injured by a specific incident at work or your work activities over time. If your primary care physician is unwilling or unable to provide care while complying with the demands of the worker’s compensation system, it may be wise to ask them to refer you to a physician who can.
If you have sustained a work injury that resulted in permanent disability, permanent wage loss, or significant amounts of lost time from work and your claim for worker’s compensation benefits has been denied, we are the law firm to call. We only practice worker’s compensation.
Worker’s Compensation attorney Luke Kingree has earned a reputation as a powerful advocate for injured workers in Wisconsin who achieves exceptional results for his clients. In recognition of the outstanding results he achieves, he has been recognized as a Wisconsin SuperLawyer. To put his expertise to work for you, contact Kingree Law Firm today.
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