Your wrist still throbs from the jam on the line when your supervisor slides a card across the desk. It names a clinic across town and says to go there today. You have seen the same family doctor in Normal for 10 years. If you visit them, will you still be eligible for workers’ compensation? Or do you have to visit the doctor your employer directed you to?
The good news is that you can still see your doctor. But there are some important rules to bear in mind before you do that.
At Dodds Law Office, we help injured workers across central Illinois solve situations like these. We walk you through your medical rights, so the choices you make immediately after the accident protect your claim instead of reducing it.
Does Illinois Workers’ Compensation Let You Pick Your Own Doctor?
Yes. Illinois law lets you choose your own doctor, and your employer pays for the treatment. That right has limits, though. You get two choices of doctor. If your employer runs an approved doctor network, seeing an outside doctor before you report your injury can use up one of them.
How Does the Two-Choice Rule Work?
The limit of two applies only to doctors you choose on your own. You can see more than two doctors without going over the limit. Your employer must pay for first aid and emergency treatment, and those visits never count against you. Beyond that, your employer pays for the first doctor you choose and any doctor that first doctor sends you to, down the full line of referrals. The same holds for a second doctor you choose.
Here’s a summary of how the visit types affect your number of choices:
| Type of visit | Does it use one of your two choices? |
| First aid at work or a trip to the ER | No |
| The first doctor you pick | Yes, this is choice one |
| A specialist, therapist, or surgeon your first doctor refers you to | No, it falls under choice one |
| A second doctor you pick on your own | Yes, this is choice two |
| A third doctor you pick on your own | Your employer does not have to pay unless it agrees to |
Once you use both choices, your employer picks and pays for any further treatment for your work-related injury. You can still see any doctor you want, but you pay that bill yourself.
What Changes If Your Employer Has a Preferred Provider Program?
Some employers use a preferred provider program. That is a state-approved network of doctors. For injuries on or after June 28, 2011, these rules apply if your employer had an approved program on the day you got hurt:
Your employer must tell you about the program in writing on a form the state sets;
After you report your injury, you can turn down the network in writing at any time; and
Turning down the network uses one of your two choices.
In other words, you can still leave the network for a doctor you trust, but you will have one pick left after that. The order of your steps can be important. If you see a doctor outside the network for a non-emergency visit before you report the injury, the law counts that visit as one of your choices.
Picture a worker who stops at a walk-in clinic for a sore back on the drive home, then tells the boss the next morning. That worker may have spent a pick without knowing it. Outside of an emergency, report the injury first, ask if your employer has a network, and then choose.
Can You Switch Doctors Once Treatment Starts?
You can, but each switch you make on your own uses a choice. Asking your current doctor for a referral to a specialist keeps your second choice in reserve.
The state agency that decides these claims can also step in. If it finds that your doctor is providing improper or poor treatment, it can order you to choose another doctor. If you refuse, the agency can excuse your employer from paying that doctor’s bills until you comply.
Do You Have to See a Doctor Your Employer Picks?
In many cases, yes. If you are entitled to disability payments, your employer can send you to a doctor it selects for an exam that insurers often call an independent medical exam. The exam must be at a time and place that is reasonably convenient for you. It looks at how serious your injury is, how long it may last, and what benefits you are owed.
Your employer pays for the exam, and you may bring a doctor of your own at your own cost. If you refuse the exam or obstruct it unnecessarily, your payments will stop until the exam takes place. This visit is an exam, not treatment, so your own doctor still guides your recovery.
Who Pays the Bills for a Work-Related Injury?
In addition to first aid, your employer pays for the medical, surgical, and hospital treatment reasonably required to heal or ease your injury. If your employer has a negotiated rate with the provider, it pays that rate. If not, it pays the provider’s actual charge or the state fee schedule amount, whichever is lower.
When your employer does not dispute a bill, it pays the provider directly on your behalf. Your employer must also pay for the treatment and training you need for physical, mental, and job rehabilitation.
Talk with a Bloomington Lawyer Before You Use Up Your Choices
Terry Dodds grew up in Bloomington-Normal. He earned his bachelor’s degree at Illinois State University and has practiced law in Illinois since 2001. Before opening his practice, he handled trials and appeals at a Missouri firm that represented injured workers in workers’ compensation claims.
Reach out to Dodds Law Office for a free consultation, and let Terry help you make doctor choices that protect your recovery and your claim.
FAQs
How Long Do I Have to Tell My Employer About My Injury?
Tell your employer as soon as you can, and no later than 45 days after the accident. A mistake in your notice will not end your claim unless your employer proves the mistake unfairly hurt its side. Report in writing so you have a record.
Will My Employer Pay for Travel to the Doctor’s Exam?
If you live in Illinois, yes. Your employer must send enough money for travel and meals along with the notice of the exam time and place. If the exam or the trip costs you work time, your employer must repay those lost wages based on your average daily wage.
Do I Get a Copy of the Exam Doctor’s Report?
Yes, if your own doctor did not attend the exam. The exam doctor must give you or your representative an exact copy of the report sent to your employer. It must arrive at least 48 hours before any hearing the state agency holds on your claim.
What Is a Panel of Physicians?
A panel is a list of doctors that your employer and its workers, or their chosen representative, agree on and the state approves. Your employer must post the list where workers can see it. If you are unhappy with your first panel doctor, you can switch to another doctor on the list.
Legal References Used to Inform This Page
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