Can You Choose Your Own Doctor for a Kentucky Workers’ Compensation Claim?

A workplace accident or illness often causes serious, even life threatening, injury to the worker. If you have suffered a workplace accident or illness in Kentucky you are likely covered under the Kentucky Workers’ Compensation system. As a covered worker, you will receive both medical treatment and wage replacement benefits for your injury or illness. One concern that workers frequently have is whether they have the right to choose their own doctor when being treated for a workplace injury. Only an experienced Kentucky workers’ compensation attorney can evaluate the facts of your claim and tell you with certainty what rights you have. A better understanding of some of the general rules and guidelines may be helpful in the meantime.

As a general rule, a worker does have the right to choose the doctor. A worker always has the right to seek emergency care at the emergency department of his or her choosing. The right to choose emergency care extends to situations that occur after the initial work-related accident as well. For example, if you suddenly have extreme pain two months after the initial injury you may seek care at the emergency room of your choice.

Unless your employer is part of a managed care system, you also have the right to choose your own treating physician for your workers’ compensation injuries or illness. Your treating physician will handle your medical care and treatment throughout your workers’ compensation case as well as refer you to specialists if a referral is necessary.

The costs of your medical treatment including co-payments will be paid by your employer. It’s unlawful for injured workers to be required to pay co-pays, and medical providers are not allowed to bill workers for the unpaid balance of medical bills, not covered by workers’ compensation.

If you become unhappy with your treating physician for any reason,  you have the right to change doctors one time during your claim. Any additional changes must be approved by your employer, your employer’s workers’ compensation insurance carrier, or the Administrative Law Judge assigned to your case.

The exception to the general rule allowing a worker to choose his or her own doctor occurs when the employer participates in a managed care system. In that case, you must choose a “gatekeeper” physician who will act as your primary treating doctor for your workers’ compensation claim.

In Kentucky, a managed care system must prove that it meets the standards set by the Department of Workers’ Claims to be an eligible managed care system that treats workers’ compensation claimants. A managed care system is required to have sufficient specialists within the system to treat most injuries. If surgery is recommended, you have the right to a second opinion at your employer’s expense.

If you have been involved in a Kentucky workplace accident, or are suffering a job related illness, and you have specific questions about the benefits to which you are entitled or about your right to choose your doctor, contact an experienced Kentucky workers’ compensation attorney right away to ensure that your rights are protected throughout the duration  of your workers’ compensation claim.