Can I Choose My Own Doctor for Workers’ Compensation in Oregon?

One aspect of filing a workers’ compensation claim that makes some employees uneasy is the prospect of getting medical care from an unknown healthcare provider. Individuals form tight bonds with their doctors and staff. When you must see a new physician during a challenging time, you may feel uncomfortable and question whether you are getting the best care possible.

At the law firm of Jodie Anne Phillips Polich, P.C., we understand your apprehension. Our legal team wants to shed light on the Oregon workers’ compensation process and help you understand the situations where you may or may not be able to see your own medical provider.

Can the Employer’s Workers’ Compensation Insurer Pick Your Doctor?

It depends. In Oregon, unless your insurer has enrolled you in a managed care organization (MCO), you can be treated by any healthcare provider who qualifies as an attending physician. Your employer does not choose your healthcare provider for you.

An MCO is a group of medical caregivers with certification from the Workers’ Compensation Division. The MCO is responsible for coordinating all medical care related to the injury, including selecting a doctor to treat the worker. The insurer can influence the choice of MCO, which may affect which doctor you see.

Do I Have the Right to See My Own Doctor?

You have the right to choose your medical provider for immediate medical treatment and continued medical care. If your employer enrolled in a managed care organization, you may have more limited options. However, you can still choose your provider within the parameters of your organization’s MCO.

If your employer enrolls you in an MCO, they’ll send a letter advising you that they have done so. Typically, you have 14 days from that letter’s mailing date to continue treatment with your non-MCO provider before you’re required to treat with a new provider from the MCO network.

Can I Get a Second Opinion for a Workers’ Compensation Injury?

If you feel your medical care or treatment is inadequate, you can seek a second opinion on a workers’ compensation injury. If an MCO manages your care, you can request a change to a different doctor within the MCO’s network. If you’re still not satisfied with the care you’re receiving, you may be able to request an independent medical examination (IME) by a doctor of your choosing. However, this may require approval from the workers’ compensation insurer.

An insurer can also request an IME to address issues such as the cause of your injury, treatment options, and work restrictions. Even if you choose your own medical provider, you could be required to see another physician by the workers’ compensation insurance provider.

Who Decides Disputes Over Medical Treatment?

You can file an appeal should an MCO deem a treatment or medical service unnecessary or if you disagree with an MCO’s decision. First, the MCO must give you notice of its decision in writing. The notice contains instructions on how to file a decision appeal. When a complaint is not included in an MCO’s dispute-resolution process, you can request a review by the Workers’ Compensation Division.

The Oregon workers’ compensation system has a two-part system designed to help resolve medical treatment disputes. The Medical Resolution Unit typically reviews and attempts to resolve medical disputes involving claim classifications and claim closures. The Workers’ Compensation Board, an independent agency, can review insurer claim denials and specific claim processing issues.

Get Help from an Oregon Workers’ Compensation Lawyer Now

Receiving the benefits you need from the workers’ compensation system can be challenging. Filing an appeal or dispute can be even more daunting. Thankfully, the legal team at Jodie Anne Phillips Polich, P.C., is in your corner and can help you seek the workers’ compensation benefits you deserve.

If you need help filing or disputing an Oregon workers’ compensation claim, contact the office of Jodie Anne Phillips Polich, P.C., today for a free legal consultation.