Can Workers’ Comp Force You To See Their Doctor?

Question: Can workers’ comp force you to see their doctor?
Short answer: Not in the way most people think. No insurer can pick one doctor and lock you in. Your choices are usually limited to an approved list. The doctor you choose becomes your authorized treating physician, and their notes will largely decide how your claim plays out.

Your first instinct when you’ve been injured on the job is probably to go see your doctor. After all, they know you, they know your history, and they’re the person you trust to take care of you. The uncomfortable truth is that you don’t have as much choice in the matter as you might think.

Here’s why:  A workers’ comp claim is a financial liability for insurance companies, and the doctor’s notes are what decide how big that liability becomes. The doctor treating you determines whether your injury is “work-related,” how long you’re out, what treatment is approved, and ultimately how much the insurer pays. Naturally, the insurer wants some say in who’s writing those notes. 

That’s why workers’ comp laws in most states allow your employer to limit your choices. You get guaranteed coverage of your medical bills and a portion of your lost wages in exchange for some degree of control over who provides the care. The difference between knowing your rights and not knowing them may be the difference between a beneficial outcome and a disappointing one. In this article, I’ll walk through how doctor choice works in workers’ comp generally, how Virginia handles it specifically, and what to say (and not say) when you do see the doctor.

So Who Actually Picks the Doctor?

Every state limits an injured worker’s choice of doctor in some way. Here are examples of how this can vary across states:

• Some states (like Pennsylvania) allow the employer to direct your care for the first 90 days, but only if it has properly posted a list of approved providers and given you written notice. After that, choosing your own doctor is subject to state rules.
• Other states (like North and South Carolina) give the employer or insurer the right to select your treating physician throughout the claim, with limited rights to request a change.
• Virginia takes a middle path. The employer or insurer must offer you a “panel of physicians” of at least three independent doctors, and you choose your treating physician from that list.

So how can you be sure you are getting the care you need? It’s important to know how the laws in your state work.

How the Panel of Physicians Works in Virginia

In Virginia, where I practice, doctor choice is governed by Virginia Code § 65.2-603, which requires the employer to provide the injured worker with a panel of physicians to choose from. The doctor you select from the panel becomes your “authorized treating physician,” and the workers’ comp insurer must pay for reasonable, necessary, and related care from that doctor going forward.

For the panel to be valid, it must meet several requirements:

• The panel must contain at least three doctors. A list of one or two is not a panel.
• The three doctors must come from three separate medical practices. If two of them are partners or work at the same group, the panel is defective. That matters because a defective panel may give you the right to see your own doctor.
• At least one doctor on the panel must be qualified to treat your specific injury. A list of urgent-care providers doesn’t satisfy the law if you have a complex orthopedic or neurological problem.
• The doctors must practice within a reasonable distance of where you live or work. Sending you across the state for treatment is not a real choice.
• The panel must be offered promptly, not handed to you weeks or months down the road.

If any of these requirements are missing, the panel may be invalid, and you may have the right to choose your own doctor outside the panel, with the insurer responsible for the bill. Don’t assume the panel you receive is valid just because the adjuster says it is. Defective panels are more common than they used to be, in part because hospital and orthopedic mergers have shrunk the number of independent practices in many areas of Virginia.

Once you select a doctor from a valid panel, you generally have to keep treating with that doctor (or specialists they refer you to) for the duration of the claim. The choice you make is significant.

Can I See My Own Doctor for Workers’ Comp?

This is the question I get asked most often, and the answer depends on a few factors.

Emergencies are always covered, panel or no panel. If your injury is severe enough to require emergency treatment, go straight to the nearest ER. Workers’ comp will pay for the visit; just be sure to tell the hospital the injury is work-related so it can be billed correctly.

Routine treatment after a valid panel is offered must come from the panel. In Virginia, once you’ve been given a valid panel of physicians, you have to pick one of them. If you go outside the panel for non-emergency care, the insurer can refuse to pay, and you may be on the hook for the bill yourself.

An invalid or missing panel often gives you the right to choose your own doctor. If your employer never provides a panel, provides one too late, or provides one that doesn’t meet the legal requirements, you may be able to select your own physician and have the insurer cover it. Because this is fact-specific, run it by an attorney before you start treating elsewhere.

You may be entitled to a new doctor if your current one is no longer available. If your authorized treating physician releases you from care, retires, moves, or tells you they have nothing more to offer, you may be entitled to a new panel and a new treating doctor.

A denied claim opens up your options but shifts the financial risk to you. When the insurer denies your claim, you can see any doctor you want, but you’ll generally have to use your health insurance or pay out of pocket while the case is litigated. If you ultimately win, those bills can sometimes be reimbursed.

One practical note: if you’ve already been receiving treatment from your own doctor before reporting the injury, don’t panic. That treatment may still be covered depending on the timing and notice given. When in doubt, consult with a workers’ comp attorney. Even after you’ve selected your treating doctor, the insurance company can ask you to see one of its doctors too.

The IME: When the Insurance Company Gets to Pick the Doctor

There is one scenario in which the insurance company does get to choose the doctor. If the insurer wants to challenge your claim, your benefits, or your treatment, it can send you to an Independent Medical Examination (IME) with a doctor it selects. Here’s what you need to know:

• The IME doctor is not your treating physician and is not providing treatment. You won’t be examined for the purpose of getting better—you’ll be examined for the purpose of generating a report.
• IMEs are typically used by the insurer to challenge your benefits. The goal is usually to argue that you can return to work, that your treatment is no longer medically necessary, or that your current condition isn’t related to the work injury at all.
• You generally must attend a properly scheduled IME. Refusing without good cause can result in your benefits being suspended. If you have a legitimate scheduling conflict, work with your attorney to reschedule.
• The IME report becomes evidence in your case, and so does the way you behave during it. What you say, how you move, and even how long you sit in the waiting room may end up in the report.

This is one of the most consequential appointments in any workers’ comp claim, and how you handle it can make or break your case.

What Not to Say to a Workers’ Comp Doctor

Whether you’re at your treating physician’s office, an IME, or a follow-up appointment, the words you use end up in your medical records, and your medical records end up driving your claim. Insurers read every line of every report. So do their lawyers. Here’s what I recommend:

1. Don’t say you’re “fine” or “feeling better” if you aren’t. Patients say this out of habit, but if it shows up in your chart, the insurer will use it to argue you’ve recovered. Describe your symptoms accurately, including any pain, stiffness, fatigue, or limitations you’re actually experiencing.
2. Don’t downplay your pain or exaggerate it. If you’re hurting, say so, and use an accurate number on the 1-to-10 scale. But be sure not to overstate your pain either. Inconsistencies between your statements, your records, and surveillance video (yes, that happens) can sink a claim fast.
3. Don’t guess about how the injury happened. If you don’t remember a detail, say you don’t remember. Speculation that turns out to be wrong looks like dishonesty later.
4. Be truthful about prior injuries—but don’t volunteer them. Insurers will pull your medical history. Trying to hide a prior issue is one of the fastest ways to lose credibility, but you also don’t owe the doctor your entire medical past unless asked.
5. Don’t agree that you can return to work just to be agreeable. If a doctor asks, answer honestly based on what you can actually do—not what you wish you could do.
6. Don’t discuss who’s at fault, your employer’s character, or your feelings about the claim. Stick to the medical facts. The doctor is not your therapist, your friend, or your advocate. Their notes are evidence.
7. Don’t sign anything you haven’t read. This includes medical releases that are broader than the work injury. You generally do not have to authorize release of your entire medical history.

A useful rule of thumb: answer the medical questions honestly and accurately, and stop talking. You’re not at the appointment to make a case; you’re there to be evaluated. Let your symptoms and your records speak for themselves.

How Doctors Can Impact Your Workers’ Comp Claim

Medical records are the single most important evidence in a workers’ comp claim. What your treating doctor writes down—and what an IME doctor adds later—affects almost every major decision in the case, including:

• Whether your injury is documented as work-related, which determines if you have a claim at all
• The work restrictions you’re given and how long they last
• How long you stay out of work on wage replacement benefits
• Whether ongoing treatment is approved by the insurer
• Your impairment rating if the injury becomes permanent
• The eventual value of any settlement.

That’s why the doctor you treat with is one of the most consequential choices in the entire claim. Some approved doctors are well-respected by the workers’ comp bar. Others have reputations for minimizing injuries, denying needed treatment, or rushing patients back to work before they’re ready. Any experienced workers’ comp attorney can advise you about whether and when you have any choice in the matter, and, if so, which choice might be best.

Frequently Asked Questions

Can Workers’ Comp Force You to See Their Doctor: The Bottom Line

Workers’ comp is supposed to make life easier after a workplace injury, but for a lot of injured workers, it does the opposite. Between all of the appointments to keep, forms to sign, adjusters to deal with, and a constant sense that everyone in the process knows the rules except you, the process can get overwhelming fast. You don’t have to navigate it alone. 

If you live in the DMV area and have questions about your claim or just want to make sure you’re on the right track, the workers’ comp attorneys at Gammon & Grange are here to help. We work on a contingency fee, so you don’t pay us unless you are compensated.

This blog provides general information about workers’ compensation. It is not legal advice and does not create an attorney–client relationship. Workers’ comp laws vary by state and depend on individual facts. For guidance on your situation, consult an attorney in your jurisdiction.