Can the Insurance Company Decide Who Does Your Surgery?

Posted on November 07, 2019

In Illinois, when a serious workplace injury occurs that requires surgery, an insurance company is not permitted to force a surgical procedure or choose a physician to perform the surgery.

Illinois Workers’ Compensation Laws

According to Illinois workers’ compensation laws, an injured worker is entitled to choose his/her own doctor for work-related injuries. Although these laws vary from state to state, Illinois allows injured workers to choose any doctor within a specified medical network. Admission to the network is determined by the state, the employer, or the employer’s insurance company.

When a work-related injury occurs, the injured worker is permitted to see his/her regular doctor as long as the doctor handles workers’ compensation injury cases. An injured worker is permitted to receive treatment from any physician of choice for the initial visit. He/she is also permitted to seek treatment from a hospital emergency room if needed. The injured worker must tell the physician that his/her injury is work-related and treatment requires a workers’ compensation claim, so appropriate forms can be filled out and submitted to the insurer. Doctors who treat work-related injuries must be authorized for treatments. Otherwise, workers’ compensation payments for medical bills may be denied and medical records may not be accepted as evidence of injuries.

With Illinois workers’ compensation, a chosen doctor has the right to refer a patient to other doctors for exams and treatments if necessary. If an employer is part of a Preferred Provider Program (PPP), the employee can choose any two doctors within that network. If the employee doesn’t want to see a doctor from the preferred network, he/she may have limited options for a second opinion or further treatments.

In some Illinois workers’ compensation cases, an employer may choose the doctor for an initial examination. The employee must attend the exam but does not have to accept treatment from that doctor. In such cases, the employer must ensure that the chosen doctor’s visit is set at a reasonable place and time for the employee. The employer must also pay all expenses related to the doctor’s visit, including the cost of the exam, lost wages, and employee meals and travel expenses. The doctor must provide a copy of the exam report to the employer and the employee.

Filing a Claim for a Work Injury

When a work-related injury occurs, the injured employee should take immediate action to validate his/her injuries and ensure prompt payment from the insurance company. Following three important steps will speed up the claim process.

Report the Injury

When a workplace injury occurs, it’s essential to report the injury to an employer, manager, or supervisor right away. This will validate the place and time of the injury for a workers’ compensation claim. Under Illinois law, workers who suffer work-related injuries must notify their employer within 45 days of the accident date/injury to receive workers’ compensation benefits. Once the employer is notified of the injury, he/she has 14 days to accept or deny the claim. The employer must also file an accident report with the Illinois Workers’ Compensation Commission within 30 days. If the claim is denied, a workplace injury lawyer may file an appeal for a hearing.

Get Medical Treatment

Immediate medical treatment is essential for a work-related injury claim. An employee’s physician will keep detailed medical reports that document the place and time of the initial exam, the immediate treatment, and the diagnosis, as well as all followup treatments, prescribed medications, vocational rehabilitation, and progress reports. The physician’s medical records will be required to show proof of the workplace injury and validate the workers’ compensation claim. Medical records will also be required to validate proof of any temporary or permanent disability caused by the injury.

File a Timely Claim

Filing an untimely claim is one of the main reasons that workers’ compensation claims are denied. When an employee delays a work injury report to his/her employer, the employer may question the validity of the injury and deny the claim to the Workers’ Compensation Commission. To avoid problems with injury claims and workers’ compensation benefits, work-related injury claims must be filed in a timely manner in accordance with workers’ compensation laws.

In Illinois, a workers’ compensation claim must be filed within two years of the date of the worker’s injury. An Illinois workplace injury lawyer can guide a claimant through the legal process to ensure that all workers’ compensation laws are followed. Although workers’ compensation benefits are paid by the employer’s insurance company, it’s the responsibility of the injured employee to start the claims process by reporting the injury as soon as possible. Work injury claims are more complex than personal injury claims since rules and regulations must be followed precisely to prevent denied claims and benefits.