How Do I Change My Workers’ Compensation Doctor in Virginia?

One of the key aspects of workers’ compensation is the right to medical benefits. However, because of the complex regulatory structure, filing a claim and receiving benefits is not as easy as one might think. 

Workers’ compensation typically comes with a few requirements. For example, an injured worker needs to choose from a 3-doctor panel or list provided by their employer and its insurance provider or third party administrator. If the injured worker chooses to see a different physician, they may have to pay out-of-pocket for the treatment and care they receive. 

For those workers who may be thinking about switching to a different doctor because they’re unhappy or not confident with the quality of care they’re receiving, here are some important things to keep in mind.

What if I disagree with a workers’ compensation doctor in Virginia?

It’s not unusual for an injured worker to seek a different doctor, especially if they feel like they’re not seeing good results from the treatment they’re getting and their current doctor believes that nothing more can be done. 

Under Virginia law, there’s no specific law that prohibits getting a second opinion. But there’s also no mechanism that regulates how the process of switching providers should be done. 

How do I change workers comp doctors?

The injured worker can talk to their employer so they can discuss their sentiments and seek another 3-doctor panel that they can choose from but not all employers may allow such a request. There’s also nothing stopping the worker from seeking treatment on their own from their preferred doctor. However, that can get very expensive quickly.

For those who want to change doctors and still get the treatment covered by their workers’ compensation benefits, here are their options:

1) Ask their current doctor for a second opinion

Before doing this, the worker should make sure that their doctor can help advocate for their medical needs, especially if the insurance provider denies their right to obtain adequate medical treatment. Not all doctors are willing to do this so it’s a good idea to check what the physician thinks first.

The doctor must be able to refer to another physician directly and specifically. Avoid a generic referral that only states that the worker needs to see another doctor. It’s best to get a referral to a specific doctor, indicated in the document by their name. This makes it harder for the insurance company to deny the referral or just offer the worker a new list of doctors they can choose from.

2) Ask their current doctor to send them to a functional capacity evaluation

A functional capacity evaluation or FCE refers to a series of tests that evaluate the worker’s ability to perform their work. If the worker is happy about the treatment they’re getting but is not satisfied with the doctor’s evaluation of their work capabilities, this is their best option. An FCE will help clarify the extent of your impairment and accurately identify work restrictions.

3) Ask for permission from the insurance company to get treatment from a new doctor

In most cases, the insurance company will deny a request from the work to change doctors. However, there are a few exceptions, including the following:

• The current doctor is recommending a surgery
• The current doctors refuses to coordinate with the claims adjuster or nurse case manager
• The worker obtains an award order for temporary total disability benefit; however, the current doctor is not immediately available to provide treatment

4) File a motion to change doctors with the state’s Workers’ Compensation Commission

If the worker has exhausted all previous options, they can request a change of doctors from the Workers’ Compensation Commission

Can workers’ comp deny a second opinion?

The worker should be able to provide a reasonable justification for their motion to change doctors before the request can be granted. Essentially, the worker should be able to show proof for any of the following:

1. That they’re receiving inadequate treatment
2. That they need treatment from a specialist and their current doctor is refusing to provide them with a referral
3. That their current doctor does not have a long-term treatment plan
4. That their current doctor is using questionable treatment methods
5. That their current doctor has abandoned their care
6. That their current doctor is unable to find the cause for their pain
7. That there’s a language barrier that prevents the worker from communicating effectively with their current doctor

Call an Experienced Virginia Workers’ Compensation Lawyer for Help

When the treatment isn’t going anywhere and the pain you’re feeling is becoming more and more severe each day, you may need to change your healthcare provider. However, getting approval for this change can be an uphill battle. You’ll need a workers’ compensation lawyer who understands the law and has experience dealing with insurance agencies in the state.

Slominski Law has successfully helped countless accident victims and workers navigate the complicated workers’ compensation process. We can help you get the level of care you deserve. Call us at (434) 384-9400 or (540) 554-3762 and we’ll be happy to help.