In Washington state, work injury claimants have the right to choose their doctor or provider of care (AP) for their claim. This right is part of RCW 51.36.010. Surprisingly, many people who suffer a workplace injury are unaware that they can choose their own doctor. However, the only requirement is that the doctor or provider be part of L&I’s Medical Provider Network (MPN).
L&I claim and your right to choose a doctor
There are many reasons why people with an L&I claim or a workers’ compensation claim do not know their rights. Explicitly, the main reasons I see include:
• Not understanding how a workers’ compensation claim works. Most people have never had an L&I claim. They do not know what an assistant provider is or what its role is. In fact, the assisting provider plays a very important role in L&I claims. This provider manages treatment, reports progress, and provides critical assessments throughout the claim. Therefore, it is important for work injury claimants to choose a doctor or provider who will help them recover and manage their claim productively.
• Not realizing how a provider becomes your treating doctor. Often, the Department of Labor and Industries (L&I) considers the provider who submitted the application for benefits to be the treating physician. If that provider is an urgent care provider, it is unlikely that they will agree to be the provider of care in the workers’ compensation claim. If you had a workplace injury and received treatment in an emergency setting, you should seek follow-up care from another physician who is an effective AP.
Make your own decisions on your L&I claim
In addition to the above reasons, there are other cases where work injury victims follow the recommendations of others. In practice, many recommendations do not help you choose the right provider for your claim. Such cases include:
• Be directed to a specific clinic or medical provider. Work injury claimants often tell me that their employer told them to see a specific doctor for initial treatment. Then, when they report their on-the-job injury, the employer provides the name and address of a specific medical provider or clinic for further treatment. Here, claimants are usually under the impression that they can only see that provider.
• Get referrals to occupational medicine from a primary care physician (PCP). Some people ask their primary care doctor for guidance after a work injury. Some PCPs are members of the MPN and can easily become the treating provider. Often this is an ideal situation. However, when the PCP is part of a large medical group, the work injury claimant receives a referral to the “occupational medicine” division of the same group. These groups are usually at L&I COHE. This practice is common at The Everett Clinic and Kaiser Permanente, among others. However, many people with an L&I claim or a workers’ compensation claim do not realize that they do not have to receive treatment there. Regardless of insurance, claimants for workplace injuries can treat with any provider in the MPN. Even if the treating doctor is not part of the same medical group as your primary care doctor.
Change of doctor on your L&I claim
There is no question that the provider you serve plays a critical role in a worker’s compensation claim. A key right is the ability to choose the doctor for your claim. In addition, with some limited exceptions, you also have the right to change your doctor for an L&I claim. Changing your care provider is very simple. More explicitly, you can download and complete the Transfer of Care form (from the L&I website) and submit it to your claims administrator. As always, keep a record of all communications. This way, you can track and document your decision to appoint a new provider.
concluding remarks
In short, the provider you see plays a very important role in workers’ compensation claims. And remember: people with a work injury claim have the right to choose their care provider. Therefore, it is important to choose a doctor who will focus on helping you get better and help your claim move forward productively. Finally, if your treating doctor is not a good fit for you, then you have the right to change to a different provider.
This article was first published at https://tarareck.com/l-and-I-claim-choose-doctor/