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If you are wondering about choosing a doctor for Workers’ Compensation in Virginia, the answer depends on how medical treatment is handled at the start of the claim and whether the employer offers a valid panel of physicians. In this article, we explore…
Virginia law says that the employer shall provide a panel of physicians after the injured worker reports the injury. Normally, when a statute says “shall,” that means it is mandatory. In this area, though, it is not always treated that way in practice.
A panel of physicians can mean a list of at least three different doctors, and the injured worker chooses one from that list. In some cases, though, the employer and the Workers’ Compensation insurer do not offer a valid panel at all.
A panel may be invalid if:
If your employer does not offer a panel of doctors, you may be able to choose your own doctor, depending on your situation. However, if you’ve already started treatment with a doctor, you may have to continue seeing that doctor instead of switching to someone new. Because every case is different, it’s important to understand your rights before changing doctors.
In many cases, whether out of ignorance or because they are trying to protect their own interests, your employer may tell you, “You have to go to this specific urgent care center”. That is not necessarily true, but your employer does not have a duty to explain your rights, and it does not have to act in your best interest.
Under Virginia Workers’ Compensation case law, once a worker establishes a course of treatment with a doctor (not just one visit, but usually at least two or three visits), the Commission may treat that as acceptance of the doctor. Even if you did not understand the situation, and even if your employer or insurer misled you, you may still be stuck with that doctor.
And, with regard to where their loyalties may lie, not all doctors are equal in this setting. There is a reason the statute allows a panel process, and there is a reason insurers want control over that process. They want doctors who are more likely to serve their interests than those of the injured worker.
Your goal, in many cases, is to avoid being locked into a panel doctor if there is a legal basis to do so, because choosing your own doctor may make a significant, positive difference in the outcome of your claim.
You won’t have much say in selecting your doctor, at least not in the ordinary sense. Your employer is the one who chooses the panel, so you don’t really get a choice unless the panel is invalid or no valid panel is offered.
That is where the real issue usually lies. An unrepresented claimant often will not know whether a panel is invalid. Even if the problem seems obvious, such as most of the doctors being unreasonably far away, the worker may not know what to do about that.
For example, someone might argue with the adjuster and say, You gave me a panel of three, but two of them are an hour and a half away, so this is really just one doctor. That may be a fair point. Sometimes that happens because the insurer is trying to push the worker toward the one doctor it wants.
You could try to negotiate on this point, but that usually is not the best tactic. The better strategy is often to treat the panel as invalid and choose your own doctor. That takes confidence and knowledge that most claimants do not have on their own.
If I am representing someone, I usually do not try to negotiate over the panel first. I tell the client to choose their own doctor if the panel is invalid. Then, if the insurer later says the treatment was unauthorized, the response is simple: the panel was invalid, which is the same as not offering a valid panel at all.
Doctor choice can influence nearly every part of a Virginia Workers' Compensation case, and Terry Armentrout of Armentrout Accident and Injury Law, LLC has seen firsthand how the wrong medical path can affect treatment, work restrictions, and wage benefits. He has helped injured workers deal with panel issues, authorization disputes, referrals, and situations where they felt stuck with a doctor who was not truly helping them. His guidance comes from experience with the medical-treatment disputes that often arise early in a claim.
If you have questions about your options for care after a work injury, contact Armentrout Accident and Injury Law, LLC today.
Unfortunately, if you are unhappy with the doctor who is treating you, you may very well be stuck with them. There are ways to change doctors, but your options are limited. You and the insurer can always agree together on a change of doctor. But you cannot simply decide on your own to switch and expect Workers’ Compensation to pay for it.
One possibility is that your current doctor refers you to another doctor. If an authorized treating physician refers you to a specialist or another provider, that new doctor usually becomes authorized as well. But if the doctor is part of the panel system and is working comfortably within that system, they may have little incentive to help you move outside it.
Another possibility is to ask the insurance company to agree to a different doctor. Sometimes, claimants (including unrepresented ones) are able to get the insurer to agree to add another doctor or provide another panel.
In rare cases, if you can show that something serious is going on, such as malpractice or an outright refusal to provide treatment, the Commission may order a change of physician.
There is also a more practical option in some cases. If you have health insurance, Medicaid, or Medicare, you may decide to seek treatment with a doctor of your own choosing and use that other coverage. That means giving up Workers’ Compensation payment for that treatment, but it may still be worth it if the authorized treating doctor is not helping you and is hurting your ability to receive wage benefits.
One possible response is to try to change doctors. But there are also other ways to challenge an early release.
One option is to get a second opinion. That is not the same thing as changing your authorized treating physician, but a second opinion may still help show that you are not ready to return to full duty.
Sometimes you can challenge the release by showing that the doctor’s opinion was not informed. For example, if the doctor says you can return to your regular job, but the doctor was never given an accurate job description and does not understand the physical demands of the work, that may undercut the release.
Most of the time, though, your strongest option is getting another doctor’s opinion that disagrees with the treating doctor. That is often the most effective way to challenge a release that came too soon.
Seek legal help as early as possible. The reason is simple: who you see for treatment matters significantly, and that decision is usually made very early. In some cases, it is effectively locked in within days of the accident—certainly almost always within the first 30 days. If you do not know your rights, you may not know whether the panel is valid, whether you have to accept it, or whether you can legally choose your own doctor instead.
There are also strategic decisions that are not obvious to most people. For example, sometimes an injured worker reports the injury and then starts repeatedly calling the insurance company asking for a doctor. That feels like the right thing to do, because the person needs treatment. But in some situations, that is exactly the wrong move. The employer and insurer only have a reasonable amount of time to offer a panel. That time is not unlimited. In some cases, the better strategy is to wait quietly long enough for that opportunity to pass, so the employer loses the right to control the doctor choice and the worker can choose their own doctor instead. That can make a major difference in whether the worker receives the full benefits they are entitled to. But most people understandably do the opposite. They press for treatment right away through the insurer, and in doing so, they may prompt the insurer to act before its opportunity would otherwise have expired.
That is just one example of why getting early legal help matters. The description of your injury, the choice of doctor, and even whether a light-duty job offer is legitimate are all issues that can arise quickly. Many of those questions involve gray areas that are difficult even for experienced attorneys.
An attorney can help evaluate those decisions before you become locked in and before you lose options that may be impossible to get back later.
For more information on choosing a doctor for Workers’ Compensation in Virginia, an initial consultation is your next best step. Get the information and legal answers you are seeking by calling (540) 564-1466 today.
Doctor choice can influence nearly every part of a Virginia Workers' Compensation case, and Terry Armentrout of Armentrout Accident and Injury Law, LLC has seen firsthand how the wrong medical path can affect treatment, work restrictions, and wage benefits. He has helped injured workers deal with panel issues, authorization disputes, referrals, and situations where they felt stuck with a doctor who was not truly helping them. His guidance comes from experience with the medical-treatment disputes that often arise early in a claim.
If you have questions about your options for care after a work injury, contact Armentrout Accident and Injury Law, LLC today.