Navigating the Massachusetts workers' compensation system can be challenging, especially when determining who has the right to choose the treating physician. Injured workers need to understand their rights to medical care, as the choice of doctor plays a significant role in treatment outcomes, recovery timelines, and the success of the workers' comp claim. This article explores how doctor selection works in Massachusetts workers' comp cases and provides practical insights to ensure you get the care you need.

Who Has the Right to Choose the Doctor?

The Massachusetts workers' compensation law follows a hybrid model regarding doctor selection. Both the employer/insurer and the injured worker play roles in determining medical care at different stages of the claim process.

First Medical Visit:

• After an injury, the employer (or their workers' compensation insurer) has the right to direct the injured worker to an approved healthcare provider for the initial treatment. This is typically required so that the insurer can confirm the injury and assess its severity.

Subsequent Medical Treatment:

• Once the first visit is completed, workers are free to choose their own doctor for ongoing treatment. This is a key difference from states where insurers retain full control over all healthcare decisions throughout the claim. Massachusetts allows employees to take control of their long-term care by selecting specialists or physicians they trust.

How to Find the Right Doctor After the Initial Visit

Choosing a healthcare provider after the initial employer-directed visit is one of the most critical decisions an injured worker can make. Workers should prioritize doctors who:

• Specialize in Work-Related Injuries: Look for professionals experienced in treating musculoskeletal injuries, fractures, and other workplace-related conditions.
• Understand the Workers' Compensation Process: Not all doctors are familiar with the paperwork and communication required in workers' comp claims. Providers with this knowledge ensure smoother claims and fewer disputes.
• Have a Good Reputation for Patient Advocacy: It's essential to work with medical professionals who will support your treatment needs, even if the insurance company tries to limit care.

Many injured workers prefer doctors outside the employer's network for fear that employer-selected physicians may have a bias toward minimizing injuries.

Are There Limits on Medical Care Choices?

While workers in Massachusetts are allowed to select their own doctors, some restrictions still apply:

• Authorized Providers: The doctor you choose must accept workers' compensation cases and may need to be part of the insurer's approved network. If not, the insurer could deny coverage for certain treatments.
• Specialist Referrals: Some treatments, such as surgeries or physical therapy, may require pre-approval from the insurer. Workers should ask their doctor to submit a detailed treatment plan to avoid delays.
• Independent Medical Examinations (IMEs): Even though workers select their own doctors, the insurer has the right to request an IME to assess the worker's condition. Refusal to attend an IME could result in a suspension of benefits.

What Happens if the Insurer Denies Care?

Workers' compensation disputes are not uncommon, especially when insurers challenge the necessity or extent of medical treatment. If a dispute arises, injured workers in Massachusetts can seek relief through the Department of Industrial Accidents (DIA). The DIA oversees hearings and mediations to resolve conflicts between workers and insurers.

In situations where medical treatment is denied or delayed:

• Workers can request a hearing with the DIA to argue that the treatment is necessary.
• Doctors may submit additional medical records to justify the treatment.
• Some workers opt for legal representation to strengthen their case, particularly if the denied care is essential for recovery.

Statistics on Massachusetts Workers' Compensation

The Massachusetts workers' compensation system handles thousands of cases each year. According to the Massachusetts Department of Industrial Accidents:

• In 2022, there were approximately 24,000 reported workplace injuries requiring medical care or lost wages.
• 60% of disputed cases involved disagreements over medical treatment or benefits.
• Injuries to the back and spine are among the most common claims, making access to specialized medical care vital for many workers.

These statistics underscore the importance of choosing the right medical providers to ensure injured employees receive adequate care and avoid unnecessary claim denials.

Tips for Managing Your Medical Care in a Workers' Comp Claim

Managing your healthcare proactively is essential when dealing with a workers' compensation injury. Here are some best practices:

• Document Everything: Keep copies of all medical reports, treatment plans, and communication with doctors and insurers.
• Follow Your Doctor's Orders: Failure to follow prescribed treatments may give the insurer a reason to dispute your claim.
• Communicate with Your Employer: Let your employer know about your progress and any work restrictions recommended by your doctor.
• Seek Legal Guidance if Needed: If you encounter issues with denied treatment or benefits, consult an experienced workers' compensation attorney.

Conclusion

In Massachusetts, injured workers gain the freedom to choose their own doctor after the initial visit arranged by their employer or insurer. This flexibility ensures that employees can receive specialized and trusted care tailored to their needs. However, it's essential to understand the rules surrounding authorized providers, pre-approvals, and the role of independent medical exams to avoid complications in the claims process. 

Injured? The Office of Brandon J. Broderick, MA Workers Compensation Lawyers, Can Help

If the unfortunate happens and you’ve been injured in an accident, don’t go at it alone. An experienced lawyer can advocate for your best interest and pursue fair compensation for your damages. At Brandon J. Broderick, Attorney at Law, you can count on us to work tirelessly for your quality of life. Our long track record of success has helped people like you move forward after sustaining an injury caused by another’s negligence. 

Contact us now for a free legal review.