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Who chooses the doctor in a Texas workers’ compensation case?

On Behalf of | Nov 24, 2023 | Workers' Compensation |

The medical benefits available through workers’ compensation are very valuable to injured workers. Unlike traditional health insurance, the benefits available through workers’ compensation generally cover all of someone’s costs rather rendering injured employees responsible for a portion of their medical bills.

Workers can receive surgery, medication and physical therapy along with other necessary treatments at no personal cost if they file a successful claim. Doing so requires that they effectively navigate the workers’ compensation system. One of the first questions that people often have about their benefits is who chooses the physician providing their care.

Most people would prefer to see their own doctors whenever possible. Does an injured worker or their employer make the decision about the doctor overseeing treatment?

There are two separate rules for physician selection

The details about an employer’s insurance coverage determine what options an injured worker has. If the insurance company providing coverage has a healthcare network, the injured worker must select a physician who is part of that network.

The only likely exception would be emergency treatment received immediately after an incident. All ongoing care will need to be through an in-network provider. There will typically be an assortment of physicians who participate with a specific network, and the final choice is up to the patient. Employers and insurance providers can suggest specific professionals but don’t have the authority to choose on behalf of the injured worker.

If the insurance company or a self-insured employer does not participate in a network, then the worker can choose essentially any doctor that they wish. However, they will want to check to ensure that the doctor is not one of the physicians in Texas who refuses to accept workers’ compensation cases. In scenarios in which a patient changes their mind about their doctor, possibly because of how a physician manages their case, they will need to receive authorization from the Division of Workers’ Compensation to switch their care to a different position.

For many workers, the ability to choose one’s own doctor is important, as those selected by employers may feel a sense of loyalty to the company, not to the patient. Learning about the rights that workers have when they require treatment for a job-related health condition can help people to make informed choices about their rights and options under the law.