After a work injury, getting the right medical care is often the first concern. Minnesota workers’ compensation rules generally allow an injured worker to choose a health care provider for treatment of a work-related injury, but there are important exceptions. The details of the employer’s coverage arrangement, the medical-care plan, and the type of treatment can affect the answer.
This guide provides general information, not advice about a particular claim. If you received a direction from an employer or insurer, save the document and consider having it reviewed before making a decision that could affect payment for care.
Contact Harvey & Carpenter for a free workers’ compensation consultation.
Can I choose my own doctor for a workers’ compensation injury in Minnesota?
Often, yes. The Minnesota Department of Labor and Industry (DLI) states that employees may choose their health care provider for treatment of a work-related injury. However, DLI also identifies circumstances in which an employer may require treatment through a designated provider or arrangement.
The key is to understand whether an exception applies before assuming that a particular provider will be covered.
When might an employer or insurer direct medical care?
DLI identifies several important exceptions:
- Certified managed-care plan: An employer may require treatment and supplies through a certified managed-care plan, subject to the applicable law and rules.
- Collective-bargaining arrangement: A qualifying collective-bargaining agreement on file with DLI may specify an exclusive list of providers for treatment and independent medical examinations.
- Pharmacy network: An employer may require outpatient prescription and nonprescription medication to be obtained from a pharmacy or network of pharmacies when the statutory requirements are met.
Emergency care should not be delayed when you need it. After the emergency is addressed, keep track of the instructions you receive about follow-up treatment.
What should I do before changing doctors?
- Read the insurer’s or employer’s written direction. Look for references to a managed-care plan, provider network, claim number, or contact person.
- Ask in writing whether the provider is authorized. If you want to see a particular physician or specialist, request confirmation and keep the response.
- Explain the reason for the request. The need for a specialist, lack of improvement, a practical access issue, or a treatment recommendation may be relevant.
- Keep records. Preserve referrals, bills, medical notes, communications, and work restrictions.
- Get advice if treatment is disputed. The available procedure can depend on whether the insurer has accepted liability and whether the dispute concerns medical care, rehabilitation, or the underlying claim.
What is the difference between my treating doctor and an IME?
Your treating provider is the clinician who evaluates and manages your care. An independent medical examination (IME) is different. DLI describes an IME as an evaluation by a doctor selected by the employer or insurer who is not involved in the worker’s treatment. The insurer may request an IME at a reasonable time and place, and missing a scheduled examination can interrupt benefits.
Read our detailed overview of independent medical examinations in Minnesota workers’ compensation claims.
What if the insurer will not pay for medical treatment?
First, identify what is being denied: the injury itself, the relationship between the treatment and the injury, the provider, the procedure, or the bill. DLI explains that the next step can differ depending on whether the insurer has accepted primary liability. In some circumstances a Medical Request may be relevant; in others, an Employee’s Claim Petition may be the required path. Notices and deadlines matter, so do not delay if a dispute is ongoing.
For a general overview of denials, see Denied Workers’ Comp Claim in Minnesota? Here’s What to Do. You can also visit our Minnesota Workers’ Compensation FAQ for answers to other common questions.
Protect your medical care and your workers’ compensation claim
Report the injury promptly, follow urgent medical advice, document the physical demands of the job, and keep copies of every notice and medical record. Questions about treatment direction often overlap with questions about wage-loss benefits, work restrictions, and claim acceptance. A focused legal review can help clarify the options in your specific circumstances.
Harvey & Carpenter represents injured workers in Minnesota workers’ compensation matters. Contact our Southern Minnesota office for a free consultation.
Source
Minnesota Department of Labor and Industry: Claim Process FAQs
