All too often, injured workers come to me after a work injury and tell me that their employer sent them to the “company’s doctor.”
At first, the employer appears to be doing the injured worker a big favor by sending them to a doctor. But, if the worker’s injury doesn’t get better within a short amount of time that initial doctor selection by the employer and its workers compensation insurance company can have bad consequences for the injured worker. The reason for this is the potential conflict of interest of the employer, its workers compensation insurance company and injured worker. The conflict arises between an employer and its workers compensation insurance company that want to contain claim costs and an injured worker who simply wants to get better.
Let’s take a look at hypothetical lower back injury which frequently occurs to a worker who has a physical demanding job lifting heavy objects routinely. I’m thinking about construction workers, truck drivers or welders, just to name a few. The worker usually has a specific mechanism of injury associated with lifting something heavy resulting in the sudden onset of lower back pain. That pain is often associated with pain or numbness going into either one or both of the worker’s legs.
The employer and its workers compensation insurance company send the injury worker to the “company doctor.” The “company doctor” diagnoses a sprain/strain type of lower back injury. Usually, the “company doctor” will order light duty along with some medications and physical therapy. Sometimes, the “company doctor” will order x-rays. This conservative approach may work. But what if it doesn’t?
If the initial conservative treatment measures don’t relieve the injured worker’s lower back symptoms, the next step is usually to obtain further testing. This often is a MRI. A MRI may reveal a protruding disk between the vertebrae in the injured worker’s back. However, a MRI is a pretty expensive test. Further, a MRI revealing a protruding disk may lead to further treatment in the form of injections and/or surgery. Again, both of these treatment options are pretty expensive as well.
Here is the conflict. The employer and its workers compensation insurance carrier have an interest in keeping claim costs low. A way to keep claims cost low is to direct the worker with the injured back to the “company doctor.” The “company doctor” may then down play the significance of the worker’s continued reports of lower back pain. That “company doctor” insists that the injured worker should be well within six to eight weeks. If the injured worker isn’t better within six to eight weeks, the “company doctor” goes hunting for other things to blame the injured worker’s current symptoms. Did the injured worker have a previous back injury? Then, it’s a previously existing condition on which the employer and its worker’s compensation insurer blame the continued symptoms and deny the claim. Or, the “company doctor” states that the injured worker is overstating symptoms or malingering. Again, the result is a denial of the injured worker’s claim.
Whatever the reason for the denial of the injured worker’s claim, the injured worker usually is pretty scared and stressed out. Without proper medical care, how is the injured worker going to get well enough to return work? Without a pay check, how is the injured worker going to pay the bills while off of work getting medical care? Then there’s the question of deductibles, co-pays and medication expenses.
A way to avoid this conflict is for the injured worker to choose his or her own doctor right after the injury instead of going to the “company doctor.” South Dakota law clearly states that an employee hurt at worker has the right to choose his or her own doctor. South Dakota Codified Laws state that “[t]he employee shall have the initial selection to secure the employee’s own physician, surgeon or hospital services at the employer’s expense.” SDCL § 62-4-1.
The injured worker is better served by going to a doctor of his/her own choosing. Usually, the injured worker chooses his or her family physician. The injured worker’s family doctor doesn’t have the loyalties that the “company doctor” has and can give the injured worker straight answers. Further and most importantly, the injured worker’s family doctor has history of treating the injured worker for other health concerns and thus knows the injured worker better. Plus, the injured worker’s family doctor usually will have access to other specialty doctors like orthopedic or neurosurgeons should the injured worker’s condition not improve with conservative treatment requiring a referral.
After a work injury, the injured worker should go to the doctor that the injured worker feels most comfortable and has the injured worker’s best interest in mind. It’s your choice as an injured worker.