Kentucky Workers’ Compensation – Can I Treat with My Own Doctor?

If you have been injured in a Kentucky workplace accident, or are suffering from a work related illness, you may be entitled to workers’ compensation benefits. Those benefits include both wage replacement and medical treatment. As a workers’ compensation recipient, you may have a number of questions. One common question claimants have is “Can I go to my own doctor for treatment?” In many cases, the answer to that question is “yes.” However, there are situations in which you do not have the ability to choose your own doctor.

Workers who file a workers’ compensation claim in Kentucky frequently told by their employer that they have to be seen by a doctor selected by the employer. This is not always the case. Whether you are able to choose your own physician depends on whether or not your employer is part of a “managed care plan”.

If your employer is not part of a managed care plan, you will be able to choose your own “designated physician” shortly after you file your claim. The designated physician will be your primary doctor for your worker’s compensation claim and will be responsible for referring you to other physicians or specialists as needed.

Within ten days after receiving notice of the injury or illness, your employer (or the employer’s workers’ compensation insurance carrier) is required to send your Form 113 (Notice of Designated Physician). You then have ten days to complete and return the form which serves as your official selection of your designated physician. You have a right to change your designated physician one time. If you wish to change a second, or subsequent, time you will need permission from your employer, your employer’s insurance carrier, or from an Administrative Law Judge.

On the other hand, if your employer is part of a managed care plan, the process is different. In that case, you will be required to choose a “gatekeeper physician” from a list of doctors supplied by your employer. While you are not forced to treat with a specific “company doctor”, your choice of doctors will be limited under a managed care plan. Your employer is obligated to provide you with written verification that the company uses a managed care plan. By law, a managed care system is required to have sufficient specialty doctors to treat common work related injuries and illnesses.

If your gatekeeper physician recommends surgery you are allowed to get a second opinion from the doctor of your choice at your employer’s cost. In addition, despite being part of a managed care system, you may still obtain medical care from another doctor if:

• It is emergency care;
• You choose to continue care with a physician who provided emergency care;
• A plan physician makes a referral;
• Necessary treatment is not available through the plan;
•  Treatment with a non-network physician was begun prior to implementation of the plan

If you have additional questions or concerns about your rights as an injured worker, contact an experienced Kentucky workers’ compensation attorney right away.