How To Handle Disputes With The Employer’s Chosen Medical Provider

How To Handle Disputes With The Employer’s Chosen Medical Provider

When a worker gets injured on the job, receiving proper medical care is critical for recovery. However, disputes often arise when the employer’s chosen medical provider disagrees with the injured worker about the diagnosis, treatment plan, or the extent of the injury. Under Illinois Workers’ Compensation laws, injured workers have rights regarding medical treatment, but many people are unaware of the steps they can take when conflicts occur.

Handling disputes effectively is necessary to protect your health and financial stability while navigating the claims process. Illinois law protects workers by ensuring they have access to necessary medical care, but conflicts can arise when the employer’s chosen medical provider minimizes injuries or pushes for an early return to work. Knowing your rights and the legal options available can make a significant difference in securing the care you need.

Understanding The Employer’s Right To Choose Medical Providers Under Illinois Law

Under the Illinois Workers’ Compensation Act (820 ILCS 305/8(a)), employers have the right to establish a Preferred Provider Program (PPP) for injured workers’ medical treatment. This program allows employers to direct an injured worker to specific medical providers for care. However, workers have important rights even when their employer has a PPP in place.

Injured workers are entitled to two choices of medical providers outside the employer’s network if the employer has not implemented a PPP. If a PPP exists, the worker may be limited to providers within that network but can still seek a second opinion. If the worker refuses care within the PPP, they may forfeit certain benefits unless they qualify for exceptions under Illinois law.

Common Disputes With Employer-Selected Medical Providers

Disputes often arise when the employer’s chosen medical provider:

  • Minimizes The Severity Of The Injury – Some providers may downplay the injury’s severity, leading to an early return to work.
  • Denies Necessary Treatments – Certain providers may refuse advanced treatments or physical therapy.
  • Clears The Worker Too Early – Premature clearance to return to work can cause further injury.
  • Questions Causation – The provider may argue the injury is unrelated to the workplace incident.

These disputes can impact the worker’s ability to receive compensation for medical care, wage loss, and disability benefits. Fortunately, Illinois law provides several options to challenge unfavorable medical opinions.

Steps To Take When Disputing The Employer’s Chosen Medical Provider’s Opinion

If you do not agree with your employer’s chosen medical provider, you do have the legal right to challenge their findings. Taking the following steps can help protect your workers’ compensation claim:

1. Seek A Second Medical Opinion

Under 820 ILCS 305/8(a), you have the right to seek a second opinion from a provider of your choice, even if you are receiving care within the employer’s network. If the second opinion conflicts with the employer’s provider, it can strengthen your case for ongoing benefits.

2. Request An Independent Medical Examination (IME)

Illinois law allows employers to request an Independent Medical Examination (IME) under 820 ILCS 305/12. However, if you believe the IME results are inaccurate, you can challenge them with evidence from your personal physician or additional medical opinions.

3. File A Petition For Immediate Hearing

If your benefits are unfairly denied due to a medical dispute, you can file a Petition for Immediate Hearing with the Illinois Workers’ Compensation Commission (IWCC). This legal step forces a review of your case, providing an opportunity to argue for continued care and benefits.

4. Maintain Detailed Medical Records

Document every appointment, diagnosis, and treatment recommendation. Detailed records help support your claim and demonstrate the need for continued care, especially when disputing a premature release to work.

5. Contact A Workers’ Compensation Lawyer

When disputes arise, working with a lawyer can help ensure your rights are protected. Legal counsel can help gather evidence, challenge unfavorable medical opinions, and represent you before the IWCC.

The Role Of The Illinois Workers’ Compensation Commission In Medical Disputes

The Illinois Workers’ Compensation Commission (IWCC) oversees disputes between injured workers and their employers. If disagreements over medical treatment cannot be resolved directly with the employer or insurance company, the IWCC can intervene.

The IWCC can review evidence from multiple medical providers, evaluate the necessity of ongoing treatment, and determine if the employer has met its obligations under the Illinois Workers’ Compensation Act. If a decision favors the worker, the employer must comply with the ruling and continue providing necessary benefits.

Legal Remedies If The Employer Refuses To Pay For Medical Treatment

If the employer refuses to cover medical expenses or challenges the necessity of continued care, Illinois law allows several remedies:

  • Temporary Total Disability Benefits (TTD) – If the worker cannot return to work due to the injury, TTD benefits cover a portion of lost wages under 820 ILCS 305/8(b).
  • Penalties For Unreasonable Delay – Employers who unreasonably delay medical care or wage payments can face penalties under 820 ILCS 305/19(k).
  • Attorney’s Fees – If the employer’s refusal to pay is found unreasonable, they may be ordered to cover attorney’s fees under Illinois law.

Illinois Workers’ Comp FAQs

What Should I Do If The Employer’s Medical Provider Clears Me For Work Too Early?

If the employer’s medical provider clears you to return to work before you have fully recovered, you have the right to seek a second opinion. Illinois law allows injured workers to consult a non-network physician if they disagree with the employer’s provider. If the second opinion supports continued care, your benefits should continue. You may also petition the Illinois Workers’ Compensation Commission (IWCC) for a hearing to challenge the clearance decision.

Can I Choose My Own Doctor After A Work Injury In Illinois?

Yes, you can choose your own doctor under certain circumstances. If your employer does not have a Preferred Provider Program (PPP), you can select two physicians outside of the employer’s network under Illinois law. However, if a PPP exists, you may be required to seek care within the network unless you opt-out. Seeking care outside the network without legal justification could impact your benefits.

What If My Employer’s Medical Provider Refuses Necessary Treatment?

If the employer’s chosen provider refuses necessary treatment, you have the right to seek a second opinion and request an Independent Medical Examination (IME). Document the denial and gather medical evidence supporting the need for treatment. Filing a Petition for Immediate Hearing with the IWCC may also help you secure approval for further care.

How Can A Workers’ Compensation Lawyer Help With Medical Disputes?

A workers’ compensation lawyer plays a crucial role in protecting your rights during medical disputes. They can help gather medical evidence, communicate with insurance adjusters, and represent you in hearings before the IWCC. Legal counsel ensures your benefits are not wrongfully denied due to an unfavorable medical opinion.

Can I Lose Benefits If I Refuse To See The Employer’s Chosen Provider?

If your employer has a Preferred Provider Program (PPP) and you refuse care within that network, you may risk losing certain benefits under Illinois law. However, you still have the right to a second opinion or to challenge medical decisions you disagree with. Consulting an attorney can help clarify your rights and protect your benefits.

Contact Our Antioch Workers’ Compensation Law Firm For A Free Consultation

At The Law Offices of Robert T. Edens, P.C., we are committed to protecting the rights of injured workers across Illinois. If you are facing a dispute with your employer’s chosen medical provider, we can help you secure the care and benefits you deserve under Illinois law. Let us fight for your rights and ensure you receive the proper treatment for your work-related injury.

If you need legal assistance with a workers’ compensation medical dispute, contact The Law Offices of Robert T. Edens, P.C. today. We represent clients in Antioch and throughout Illinois. To protect your rights and to receive your free consultation, contact our Antioch workers’ compensation lawyer at The Law Offices of Robert T. Edens, P.C. by calling 847-395-2200.

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