DO I HAVE THE RIGHT TO SEE THE DOCTOR OF MY CHOICE OR DO I HAVE TO SEE THE COMPANY DOCTOR?
If you have been injured on the job while working in the state of Kentucky or have a Kentucky workers’ compensation claim, your employer may tell you after the accident that you have to be seen and treated by the “company doctor.” This is not always true. In many instances under the Kentucky workers’ compensation system, the injured worker has the right to see the doctor or gatekeeper physician of their own choosing. For instance, you have the right to go to the emergency room of your choosing immediately after the accident. Even after you have been receiving medical care by a physician, if you have either an emergency situation or are experiencing severe pain, you still have the right to go to an emergency room of your choosing. Then, after receiving the emergency care, the physician from whom you choose to receive ongoing treatment will depend on whether your employer participates in a managed health care system.
WHAT IS A MANAGED HEALTH CARE SYSTEM?
After receiving treatment at the emergency room you again may be told that you have to be seen by the “company doctor”. This again is not always true. If your employer participates in what is called a managed health care system which has been registered with the Kentucky Department of Workers’ Claims, you will have to treat with the “company doctor”. However, in this situation the employer is required to supply the injured worker with written verification of the managed care system. Written verification includes the name and address of the employer, the name and telephone number of the managed health care system and the employee’s name and social security number. From this information, a list of physicians participating in the managed health care system can be obtained by the injured worker and a gatekeeper physician can be chosen from the list.
WHAT IS A GATEKEEPER PHYSICIAN?
A gatekeeper physician is the doctor who directs your medical care while you are recovering from your work injury. If your company does not participate in a managed health care system then you are free to choose the gatekeeper that you want to manage and direct your care. If your employer participates in a managed care system then you have to choose the gatekeeper physician from a list of physicians provided to you by the employer. The gatekeeper will refer you out to specialists as needed. You have the option to switch your gatekeeper one time without question. The second time you request a switch it has to be approved by an Administrative Law Judge.
It is important to know whether your employer has a managed health care system in which you are required to participate following a work accident. If you choose not to participate in the managed health care system, your medical bills may not be paid. Should you have any questions regarding your workers’ compensation claim, do not hesitate to contact our offices, Aguiar Injury Lawyers, PLLC.