Workers’ compensation payouts totaled an estimated $167 billion in 2021.
Are you one of the millions of workers covered by workers’ comp? If you have to file a claim for the first time, you may be overwhelmed by the process.
How do you prepare for your workers’ comp doctor appointment? How do you file your claim? What increases your chances of being approved for workers’ comp?
Workplace accidents and injuries can happen in any line of work. Knowing what to do after the accident can protect you financially and physically.
Workers’ compensation covers your medical expenses for a qualifying workplace injury. Part of the process of receiving compensation is seeing a workers’ comp doctor.
You may wonder what to expect and if the doctor will doubt your injuries. Preparing for the appointment and knowing what to expect can calm your fears and make the appointment easier to handle.
Check out our guide to workers’ comp appointments and what you need to know before scheduling.
A workers’ comp doctor is just a regular physician who treats you after a workplace injury. Some doctors specialize in treating workers’ comp injuries. Other doctors on the approved list are general practitioners who treat lots of different patients.
When you file a workers’ compensation claim, you need to see a treating doctor to verify the injuries and receive treatment. This doctor gives the initial diagnosis and treatment plan, as well as specialist referrals when needed.
Other things the treating doctor decides or recommends include:
The treating doctor fills out paperwork for the workers’ comp insurance company during the appointment. The documentation includes all the details of the appointment and your injury. The doctor uses the information you provide and the results from the exam.
A workers’ comp medical exam is similar to any doctor’s appointment. The treating doctor you choose starts with your medical history. You’ll get questions on past injuries and medical conditions and any current medications and medical issues.
The doctor may ask you specific questions about the injury. That might include what happened before the accident, how the accident happened, and what you did after the incident.
The appointment also includes a physical exam to assess the injuries. The doctor might check your reactions to different types of touch or movement to assess the pain and extent of the injury. They look at the injured body part to check for physical signs of injury.
You may undergo diagnostic testing, such as lab work or imaging tests. This helps the doctor uncover internal injuries or confirm the initial diagnosis during the physical exam.
The workers’ comp insurance company may also request an independent medical exam (IME) as part of the claims process. An IME verifies that the treating doctor’s decisions and recommendations are accurate. This may happen if the insurance company has a dispute with your claim or medical treatment or if it has more questions.
You may need to see a doctor selected by the insurance company for the IME. The exam will be similar to your initial visit with your treating physician.
The finding of the workers’ comp doctor in the IME can change the outcome of your claim. Being honest with the doctor is crucial to having a positive outcome. Don’t lie to try to make the case go your way, as it usually backfires and hurts your credibility.
Seeing a doctor should always be one of your first steps for handling a workplace accident. Even if the injury seemed minor and you don’t feel any lingering effects, seeing a doctor is a good choice.
Not all injuries show up immediately. You might experience a delayed pain a few days after the accident.
If the injury causes whiplash, you might not feel the pain for 24 hours or even a few days later. Other injuries may also result in more pain after the accident.
Your doctor may notice the signs and potential for a problem before it fully develops.
Something that seems minor now may get worse. If you seek treatment right away, your doctor may be able to treat it before it becomes more severe. This can save you from experiencing more pain.
It can also prevent the need for more invasive procedures. Those procedures often come with longer healing time and more expense.
Seeing a doctor right away also establishes your need for medical care, which can support your workers’ comp claim. If you don’t go to the doctor right away, the insurance company may argue that you don’t need treatment or that the injury was caused by something else.
The company may also argue that by waiting to go to the doctor, you made the injury worse. They’ll argue they shouldn’t have to pay for 100% of the medical costs because of the delay in treatment. You may have your claim denied since you didn’t have the injury treated before it became more severe.
An initial visit creates a paper trail showing that the accident was severe enough to seek medical treatment. If you need follow-up care, you can go back for another appointment to investigate new symptoms or pain that arises.
The treating doctor you choose submits medical records and information to the workers’ comp company. The information in those documents can affect your claim, including whether or not it’s approved. It can also affect your compensation levels.
Your doctor also makes decisions that impact your workload. They decide whether or not you are considered to have limitations or disabilities. The doctor may determine how long you can’t work.
Getting emergency medical care always comes first. But you also need to report the incident officially to your employer to qualify for workers’ compensation coverage.
No matter how minor or severe the incident, reporting it as soon as possible is important. In New York, you’re required to give written notice of the injury within 30 days.
It’s best to submit the written report to your employer as soon as possible. If you don’t need emergency treatment, file the report before you seek medical treatment. This gets the process moving quickly and ensures you don’t miss the deadline.
In New York, you’re allowed to choose your own treating doctor for workers’ compensation. This ensures you can pick someone you feel comfortable with and who will offer an impartial medical exam.
However, you may need to pick from a list of qualifying doctors. In New York, the list is quite extensive, so you should be able to find someone you like.
Before scheduling your appointment, contact the company to get this list of providers. If your primary care physician is on the list, you may choose to see that person since you’re familiar and comfortable with that doctor.
If your doctor doesn’t make the list, you’ll need to stick to the other options on the approved list. This means you may need to do some research to find a doctor that’s competent and fits your needs.
Check online reviews about the doctors that match the specialty areas you need. If you find lots of negative reviews from unhappy patients, check on other qualifying doctors.
A primary care doctor can help with some injuries, but others may require a specialist or another physician type.
If you have an injury involving the musculoskeletal system, you may see an orthopedist. This includes a wide range of injuries, including broken bones, sprains, torn ligaments, dislocations, and back pain.
Chiropractors help realign your spine after a jarring injury. Seeing a chiropractor may help speed up healing after an injury.
Neurologists handle issues with the brain and nervous system.
Choosing a doctor that specializes in your type of injury may help you receive faster and better treatment. However, a general practitioner can give you an initial diagnosis and refer you to a specialist if needed.
Your workers’ comp appointment will involve lots of questions about your medical history, the injury, and the accident that caused the injury. Being able to answer the questions quickly and concisely helps your case.
If you seem unclear or stumble through your answers, the doctor may question if you’re telling the truth. You may also give inaccurate information that doesn’t match up to previous information.
You also want to give plenty of information so you can get proper treatment.
Review the details of the accident before your doctor’s appointment. Think about when and where it happened, along with the events that led up to the incident. Recall what you did to immediately treat the injury.
Think about all of the symptoms you felt immediately following the injury and currently. Note how those symptoms have changed, whether they’ve gotten worse or improved.
Think back to past medical incidents and injuries. The doctor may ask you about preexisting conditions or previous injuries to that area of the body or other areas. Being clear on that history lets you answer the questions quickly and clearly.
Since your doctor has an impact on whether or not your claim is approved, knowing what to say is crucial for your case.
Honesty is the most important thing to keep in mind when you go to your appointment. It may seem like a good idea to hide certain parts of the incident that may go against your claim, but lying or leaving out facts during your exam may hurt your claim even more.
Doctors who are experienced in workers’ comp claims look for inconsistencies or flat-out lies in your story. They’ll report it if they feel you’re not being honest about your injuries.
The exam will likely include lots of testing, which may include diagnostic imaging, so doctors can often tell quickly if you’re faking an injury or exaggerating the extent.
Falsifying the details of your injury can also hurt your treatment. If the doctors don’t have accurate information, they can’t recommend the proper therapy, medication, or surgical options.
Tell your doctor everything you’re experiencing, even if it’s a minor symptom that doesn’t seem significant. That little thing could be a sign of a bigger problem, or it could get worse over time. Your doctor might recognize the need to treat it now before it gets more severe.
Attending your workers’ comp doctor appointment is very important. If you don’t show up or you’re running late, the doctor will likely notify the insurance company.
Skipping the appointment gives the insurance company a reason to claim you aren’t really hurt that badly. They may argue that if you truly needed medical care, you wouldn’t miss the appointment.
Ensure you schedule the appointment at a time when you know you can go. Verify that you have the appointment written down correctly.
When the doctor’s office calls to confirm the appointment, listen carefully to the date and time. If you don’t receive a confirmation call, check with the doctor’s office the day before to ensure you’re still on the schedule at the time you’re planning.
On the day of your appointment, make sure you have everything you need for the appointment. Leave early to give yourself extra time to account for bad traffic or other things that slow your trip.
If something comes up last minute, always call the doctor’s office to reschedule the appointment.
Scheduling a workers’ comp doctor appointment immediately after a workplace injury shows the insurer you truly need medical care. Know what to say and how to prepare for the appointment to increase your chances of having your claim approved.
If you’ve recently been injured on the job, don’t delay in getting your medical care. Check out the top doctors in the area to find the perfect fit for your needs.
If you or your family member have been involved in an auto accident, injured at work, or suffered a slip & fall accident in New York or New Jersey, we invite you to explore our free comprehensive library.
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