970 McHenry Avenue, Crystal Lake, IL 60014
Search
Botto Gilbert Lancaster, PC

Call Today for Your FREE Consultation

Call Us800-338-3833 | 815-338-3838

Facebook Twitter LinkedIn Google

Workers' Compensation Coverage Limits Number of Medical Opinions

Posted on in Workers' Compensation

Workers' Compensation Coverage Limits Number of Medical OpinionsAfter suffering a debilitating injury, patients often seek opinions from more than one physician. A different doctor may diagnose other problems that the patient is having or offer a more effective treatment. For people who were injured at work, Illinois’ workers’ compensation law allows them to seek an opinion from a second doctor, with the employer still covering the cost of the visit. However, getting an opinion from a third doctor may not be covered, which would leave the injured employee liable for the cost.

Example

In the case of L&M Supervac v. Illinois Workers’ Compensation Commission, an employee injured his shoulder while performing his work duty of lifting heavy trash cans. The employee went to an emergency room to see a doctor, which the employer agreed to pay for out of pocket to avoid an increase in its insurance premiums. After appointments with the doctor and an independent medical examiner representing the employer, the employee twice underwent surgery to relieve the pain in his shoulder. With the pain persisting, he sought the opinion of another doctor, who identified other damage in the shoulder area. However, the man, who no longer worked for the employer, had not received permission for any further doctor visits. The former employer disputed that the man’s injury originated from work and claimed that he exceeded the number of physicians he was allowed to consult. The Illinois Workers’ Compensation Commission and subsequent courts found that the evidence soundly pointed to the injury coming from his work. However, they ruled that the man used three choices of doctors and must pay for the visits with the third doctor. The reasoning was:

  • The first doctor was the one assigned to him in the emergency room;
  • The second doctor was the one he visited after his initial surgeries; and
  • The independent medical examiner became his third doctor when the man consulted him without the employer’s approval after visiting the second doctor.

Rule of Law

The Illinois Workers’ Compensation Act states that an employer is only responsible for paying for appointments with the employee’s first two doctors of choice. The employer can also have a panel of available doctors that an employee must choose from in order to receive coverage. However, a physician from the panel may refer the employee to another physician outside the panel at the employer’s expense.

It is in your employer’s financial interest to cover no more of your medical expenses than is required following a workplace injury. A McHenry County workers’ compensation attorney at Botto Gilbert Lancaster, PC, can determine which medical expenses your employer should be responsible for. To schedule a free consultation, call 815-338-3838.

Source:

http://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=2430&ChapterID=68

Illinois State Bar Association State Bar of Wisconsin Crystal Lake Chamber of Commerce Illinois Trial Lawyers Association McHenry County Bar Association
Back to Top