What Does the Treating Physician Do in a Workers’ Compensation Case?

Published on Feb 17, 2023 at 9:30 pm in Workers Compensation.

What Does the Treating Physician Do in a Workers’ Compensation Case?

The job of a treating physician in a workers’ compensation case is to diagnose your condition and provide a suitable treatment plan. It seems straightforward—like any other case of injury or illness a doctor handles.

But things can be much more complicated than they seem. Doctors handling workers’ compensation cases have to consider much more than just your physical condition.

As such, choosing a physician in your workers’ comp case is an important task. You need someone who is not just a top-notch medical care provider but who will also be your advocate when the insurance company tries to take away your right to fair compensation.

Below, we’ll look at what the treating physician does in a workers’ compensation case. If you suffered an on-the-job injury in Maryland and have questions about how to secure benefits, a workers’ compensation lawyer from Belsky & Horowitz, LLC can provide answers. Schedule a free consultation to discuss your case in detail.

Why Choosing the Right Doctor Is Important in a Workers’ Compensation Case

Different states have different laws regarding who can choose the doctor to treat injuries in a workers’ compensation case. In Maryland, the injured worker has the right to choose their own medical provider. A qualified physician must be someone who is willing to provide treatment in a workers’ compensation case and follow the rules of the Maryland Workers’ Compensation Commission’s Medical Fee Guide.

While the injured employee has the right to choose their own doctor, employers and their insurers will often provide a list of qualified local medical providers. This may seem like a convenient way of finding a good doctor who understands how workers’ comp cases work—but be careful.

Doctors on these lists usually have long-standing relationships with the insurance companies. These physicians are often on the insurance company’s side, not yours. This means they will prioritize the company’s best interests over yours. For example, if the doctor states that your injury was the result of a pre-existing condition rather than the at-work accident, the insurance company gets to save money by denying your claim. This leaves you to bear the necessary medical expenses yourself.

It may seem impossible that a doctor would behave in this way. But this is, unfortunately, a very common practice in our modern hospital systems that are often financially intertwined with powerful insurance companies.

No matter who your doctor is, the judgments they make about your condition will form the basis of your workers’ compensation claim. Your doctor has the power to say:

  • How serious your injuries are
  • What treatment and therapy you require
  • How long you should be out of work
  • Whether you can go back to work at all
  • What restrictions and accommodations you need if you go back to work
  • Whether you suffered any permanent disability

In a very direct way, your doctor makes the call on what benefits you can receive through a workers’ comp claim.

Because the decision the physician reaches regarding the cause and nature of your injuries is fundamental to your claim, you need to make sure you work with a medical professional who is competent, attentive, knowledgeable, and willing to put in the effort needed to reach a correct diagnosis. Otherwise, you may not get the benefits you deserve by law.

But the right physician in a workers’ compensation case needs to be more than just a skilled medical practitioner. The insurance company will be highly motivated to take control of deciding what benefits should be paid out in a claim—and one of the ways they do this is by calling into question the doctor’s judgments.

The insurance company will often hire a doctor or nurse to review the doctor’s diagnosis and proposed course of treatment. This medical professional will not treat you as a patient, but they will critique the judgments your treating physician has made. A common tactic is for this peer reviewer to call your doctor and make inquiries that challenge the accuracy of a diagnosis or the necessity of a treatment. If the doctor isn’t able to answer the call and make a strong case to defend their decisions, the insurance company may be successful in disputing the truth of the diagnosis or treatment plan.

This means the doctor you choose must be ready to stand up for their own work and be available to give statements within the often-limited time frames they have to make a defense.

In these ways, the burden on the shoulders of a treating physician in a workers’ compensation case can be a heavy one. Selecting the right medical care provider is all the more important for this reason.

What a Doctor Does in a Workers’ Compensation Case

So what exactly does the treating physician do in a workers’ compensation case? Here are just a few of the important responsibilities the doctor holds when they agree to treat your work injuries.

Diagnose Your Condition

A doctor makes the call on what tests should be used to determine the exact nature of the condition. This could mean the lead physician needs to order blood tests or medical imaging tests like an MRI, CT scan, or X-ray. The doctor will also perform important diagnostic tasks like asking questions, observing your movements, analyzing biological data, examining medical history, testing reflexes and range of motion, and making other clinical observations.

The diagnosis your doctor eventually reaches is an essential component of your workers’ compensation case. For example, if the doctor underestimates the severity of your injuries or fails to link the injury or illness to the work accident or environment, you may not be able to receive benefits through a workers’ comp claim.

Refer You to Specialists

Many conditions require the expertise of a specialist who has more focused training than a general practitioner. Depending on your condition, your doctor may call in the expert opinion or treating techniques of a:

  • General surgeon
  • Orthopedic surgeon
  • Neurologist or neurosurgeon
  • Psychiatrist
  • Radiologist
  • Pain management specialist
  • Pulmonary physician
  • Chiropractor
  • Ophthalmologist or audiologist

Create a Treatment Plan

After your condition is fully diagnosed, your treating physician’s next duty is to create a plan to help you fully recover or reach maximum medical improvement (MMI). The length and type of treatments will be determined, which may involve:

  • Regular visits to a doctor or specialist for a set amount of time
  • Surgery
  • Prescription medications
  • The use of medical devices like crutches or a brace
  • Physical therapy
  • Occupational or vocational therapy
  • Mental health counseling
  • Pain management therapies
  • Chemotherapy, radiation, or other cancer-fighting treatments after exposure to carcinogens in the workplace

Determine Your Ability To Perform Your Job

Your treating physician will determine how much time you need to take off work and whether you will ever be able to return to your previous position of employment.

If you do return to work, your doctor may need to apply conditional restrictions or accommodations. These may limit things like the amount of time you can spend on your feet or the maximum weight you can lift in your condition. These restrictions and accommodations may be temporary or permanent.

Your workers’ compensation benefits for missed work time will be based on these decisions made by your doctor. This makes your doctor responsible for the type of benefits you receive, whether:

  • Temporary Total Disability (TTD),
  • Temporary Partial Disability (TPD),
  • Permanent Total Disability (PTD), or
  • Permanent Partial Disability (PPD) benefits.

Protect Your Rights With the Help of a Skilled Maryland Workers’ Compensation Attorney

If you aren’t sure where to turn for medical or legal help, we have the answers. Our skilled and experienced workers’ compensation attorneys always prioritize the needs and wellbeing of our clients. We make sure you find the right physician who can treat your injuries and give you the best chance at a complete recovery or maximum medical improvement.

You need a strong team who can advocate for you when your employer’s insurance company doesn’t. Both your medical and legal team should be there to offer protection, guidance, and support from start to finish.

We invite you to schedule a free case evaluation with one of our attorneys today. This no-obligation consultation will equip you with the knowledge to make the best decisions for yourself after a workplace injury or occupational illness.



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