Can I See a Specialist for My Work-Related Injury?

After your workplace accident or identifying your work-related injury, the first appointment you schedule may be with a general practitioner. However, they may inform you that they cannot provide the targeted care you likely need, and subsequently refer you to a specialist. But if you in the process of collecting workers’ compensation benefits, you may be unsure whether this additional medical attention will be permitted. Well, please follow along to find out whether you can receive coverage for a specialist visit with workers’ compensation, and how one of the proficient Illinois workers’ compensation benefits lawyers at The Law Firm of Kevin A. Moore can help you avoid mistakes that would lead to unnecessary expenses. 

Can I visit a specialist with a workers’ compensation plan?

Simply put, Illinois law requires your employer’s workers’ compensation program to cover all reasonable and necessary medical care related to your workplace accident or work-related injury. So, depending, on your current physical state, this may include your appointments with and treatments by medical specialists, such as neurologists, orthopedic surgeons, physical therapists, occupational therapists, and pain management professionals. 

However, this is not to say that your employer’s insurance carrier will not attempt to push back on this additional expense. That is, they may challenge whether your injury’s severity and recommended treatment plan meet these criteria, and subsequently refuse payment. This is when you may have to exercise your legal right to a hearing, presided over by an arbitrator appointed by the Illinois Workers’ Compensation Commission (IWCC). 

How do I avoid out-of-pocket expenses for specialist care?

Even if your employer’s insurance carrier does not give you any issues for covering your specialist care, you must follow proper procedures. Otherwise, you may incur hefty out-of-pocket medical expenses that you could have otherwise easily avoided. For one, the state of Illinois observes what is known as the “two-doctor choice rule.” With this, you may select two doctors before having to use employer-directed care for your work-related injury.

Say your first choice for treatment is with a general practitioner. They may then refer you to a specialist who they believe can give you the most appropriate healthcare. Well, importantly, with a formal referral like this, a specialist may not count as a separate choice towards your two-doctor maximum. Of course, your employer’s insurance carrier may try to argue that this referral was unauthorized and refuse payment, which is where your lawyer will intervene. 

We understand just how desperate you may be to get the medical care and financial aid you require to make a full recovery. The best way to get closer and closer to this goal is to have a legal representative guide you. Please retain the services of one of the talented Illinois workers’ compensation benefits lawyers from The Law Firm of Kevin A. Moore today.