Medical Care FAQs
Why Can′t I Choose My Own Doctor?
The Workers′ Compensation Law gives the employer the right to select the health care providers for the injured worker. The employer usually delegates that right to the insurance company. This does not necessarily mean that the insurance company "directs" the medical care; the treating physician selected or "authorized" by the employer/insurer directs the medical care using his or her own independent medical judgment. However, the employer/insurer does have a qualified right to select or authorize a change in physician if the employer/insurer disagrees with the authorized treating physician.
It is important to note that while the employer usually delegates the right to select the health care providers to the insurance company, it is the employer′s right. Therefore, if the employer and the insurance company disagree on this matter, the employer′s wishes should prevail.
Section 287.140 RSMo states, in part: "If the employee desires, he shall have the right to select his own physician, surgeon, or other such requirement at his own expense." Therefore, you can choose your own doctor, but at your own expense. Because of the expense, this is often not much of a choice. If you have health insurance, it may not be helpful to you in a workers′ compensation case, as many health insurance policies have an exclusion for work-related injuries. MO HealthNet (formerly Medicaid) may pay for treatment if you qualify, but there may be restrictions.
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Why Do I Have to Travel So Far For My Medical Treatment?
Sometimes it is necessary to travel to see a physician. In situations in which an employee is required to submit to treatment at a place outside of the local or metropolitan area from the employee′s principle place of employment, the employer is required to pay the necessary and reasonable expenses. In no event is the employer or insurer required to pay transportation costs of more than 250 miles each way from the place of treatment. If the injured worker resides outside of Missouri, the employer has the option of selecting the treatment at a location within 100 miles of the injured worker′s residence, place of injury, or place of hire by the employer. If you are concerned about having to travel too far for medical treatment, particularly if the travel is making your condition worse, talk to the insurance company about your concerns. If that doesn′t help, you may request assistance from the dispute management unit or ask for a conference with an administrative law judge to discuss your concerns.
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What If I Am Unhappy With My Medical Treatment?
If you are unhappy with your medical treatment, or you think that you need a referral to a specialist or some additional testing, talk to the insurance company about your concerns. If that doesn′t help, you may request assistance from the dispute management unit or ask for a conference with an administrative law judge to discuss your concerns.
If you have filed a claim for compensation, you can ask that your case be scheduled for an evidentiary hearing (trial) to have the judge decide if the employer/insurer is required to provide you with additional medical treatment, such as specific testing, a referral to a specialist, or surgery. In rare cases, if the judge believes that the manner in which medical treatment is being provided may be endangering your health or recovery, the judge may allow you to select your own physician. The employee has the burden of proof on all issues, and medical evidence is required. For more information about these types of evidentiary hearings, read What to Expect If Your Case Goes to Trial.
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What If My Medical Bills Don′t Get Paid?
If you have sustained an injury or occupational disease covered by the Missouri Workers′ Compensation Law, any health care provider selected, approved, or authorized by the employer or the workers′ compensation insurance company should not attempt to collect any fee or any portion of a fee directly from you. However, you are protected against such collection efforts only if you notify the health care provider in writing by certified mail that the health care services provided to you involve a workers′ compensation case. The notice should include:
- The name of the employer;
- The name of the workers′ compensation insurance carrier, if known;
- The name of the employee receiving the services;
- The general nature of the injury; and
- Where a claim has been filed, the claim number, if known.
As unpaid medical bills are usually the result of miscommunication between the health care provider and the insurance company, you should always talk to the insurance company as soon as you know of unpaid bills.
If the employer or the workers′ compensation insurance company refuses to pay bills for authorized medical treatment, when your case goes before the administrative law judge for an evidentiary hearing (trial), you can ask the judge to order the employer/insurer to pay the medical bills. If the judge believes that the employer/insurer refused to pay the medical bills without reasonable grounds, the judge may order the employer/insurer to pay additional amounts for your lawyer′s fees and costs. For more information about these types of evidentiary hearings, read What to Expect If Your Case Goes to Trial.
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What If The Insurance Company Just Refuses To Provide Medical Treatment?
When the workers′ compensation insurance company refuses to provide treatment at all, or discontinues your medical treatment, it is usually because of one or more of the following:
- Your case is being denied. Your case may be denied because the employer/insurer believes you did not sustain your injury at work, that the incident that caused your injury does not meet the definition of "accident," that you failed to provide the proper notice, etc.
- The employer/insurer believes that your work-related injury or condition has reached "maximum medical improvement" (that you have recovered as much as possible and, therefore, no additional medical care is reasonably needed).
- The employer/insurer believes that the condition for which you are being treated, or are seeking treatment, is the result of a preexisting condition, and not the result of the work accident.
- The employer/insurer believes that you have been non-compliant with your medical treatment or have abandoned your medical treatment (for example, missed appointments).
If you are confused as to why your medical treatment has been refused or discontinued, ask the insurance company for an explanation in writing. Often, treatment is refused or discontinued because of miscommunication, delays in receiving information, or incorrect or incomplete information. These problems can usually be resolved by communicating with the insurance company. If that doesn′t help, you can ask for a conference with an administrative law judge to discuss your concerns.
If you have filed a claim for compensation, you can ask that your case be scheduled for an evidentiary hearing (trial) to have the judge decide if the employer/insurer is required to provide you with medical treatment. The employee has the burden of proof on all issues, and medical evidence is required. For more information about these types of evidentiary hearings, read What to Expect If Your Case Goes to Trial.
If you believe the employer/insurer has refused or discontinued your medical treatment without legal cause, you may have the right to obtain medical treatment on your own, and when your case goes before the administrative law judge for an evidentiary hearing (trial), you can ask the judge to order the employer/insurer to pay the medical bills. For more information, read What to Expect If Your Case Goes to Trial.
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Is There A Limit on the Number of Medical Examinations and Evaluations?
Section 287.210.1 RSMo states: "after an employee has received an injury he shall from time to time thereafter during disability submit to reasonable medical examination at the request of the employer (or) his insurer". The only restriction on medical examinations is the word "reasonable". Multiple examinations may be reasonable when the employee has multiple injuries or conditions, or treatment continues for several years. Section 287.210.1 RSMo, also states that if the employee "refuses to submit to the examination or in any way obstructs it, his right to compensation shall be forfeited during such period unless in the opinion of the (judge) the circumstances justify the refusal or obstruction".
Section 287.143 RSMo, states: "An employee shall submit to appropriate vocational testing and a vocational assessment scheduled by an employer or its insurer." Vocational testing and assessment are generally performed by "vocational rehabilitation counselors"; these persons are usually not physicians, but do have specialized training or experience in the area of vocational rehabilitation, job training, and placement. Vocational testing and assessment are usually done only in cases in which the employee is alleging that he is permanently and totally disabled (that is, no longer able to work at any job).
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Can I Receive Copies of My Medical Records?
Yes. Under the law, every hospital or other person that provided the medical care and treatment to the injured employee shall allow its records to be copied and to furnish full information to the Division or Commission, the employer, the employee or his dependents and to any other party to the workers"e compensation proceeding. The Missouri Workers"e Compensation Law does not address the copying costs that may be charged by the hospital or other health care providers. Pursuant to Section 191.227.2 RSMo, a health care provider may charge a fee for copying, in an amount not more than seventeen dollars and five cents plus forty cents per page for the cost of supplies and labor; postage, to include packaging and delivery cost; and notary fee, not to exceed two dollars, if requested. The Missouri Department of Health and Senior Services is required to report the annual adjustment and the adjusted fees that are authorized in Section 191.227 RSMo on its Web site.
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If I Have to Go To the Doctor During My Work Shift, Do I Have to Take Leave Time?
Under the Missouri Workers′ Compensation Law, an employer may allow or require an employee to use accumulated paid leave, personal leave, medical leave, or sick leave to attend to medical treatment, physical rehabilitation visits, and rating evaluations.
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Understand Your Rights and Obligations: Consult With A Lawyer
If you have any questions about the issues discussed above, you may consult with a lawyer. If you are unable to locate a lawyer who practices workers′ compensation law, you may wish to contact the Missouri Bar Lawyer Referral Service at 573-636-3635, the St. Louis Metropolitan Bar Lawyer Referral Service at 314-621-6681, the Springfield Metropolitan Bar at 417-831-2783.
It should not cost you anything to consult a lawyer. Lawyers who regularly practice workers′ compensation law offer free initial consultations. For more information, see Obtaining A Lawyer on this website.
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DISCLAIMER - More Information
The Injured Workers section of the Workers' Compensation portion of this web site is targeted specifically to injured workers and is intended to be a resource throughout the workers' compensation claim process. It is NOT intended to be a substitute for legal representation.
Employers seeking information about the workers' compensation process and their responsibilities regarding workers' compensation should use the Employers section of the Workers' Compensation portion of this web site to find information targeted specifically to them.
Additional information about Missouri Workers' Compensation laws, the Division of Workers Compensation, the Second Injury Fund and more may be found via the Workers' Compensation home page.
Please keep in mind the information specialist cannot act as your legal counsel and cannot give you legal advice. The information specialist can provide you with general information but cannot advise you whether the settlement offer is appropriate for your injury.