Managing medical treatment issues as a Missouri workers' compensation claimant
According to Missouri's Workers' Compensation Law, your employer has the right to choose the injured employee's health care provider. Most employers will then delegate that responsibility to their insurance carrier. However, this does not mean that an injured worker's medical care is in under the control of the insurance company. Medical treatment is always under the control of the treating physician selected by the employer or insurer. Problems can arise, however, because insurance companies are responsible for authorizing and directing care--which means that there are situations where reasonable care is not provided.
What if the injured employee disagrees with the diagnosis, or is unhappy with the health provider chosen for him/her?
Missouri law allows employees to select their own doctor, surgeon, or other medical provider, but the employee must pay for that treatment themselves. This happens infrequently, because of the high cost of medical treatment. Even if the injured party has medical insurance, many policies will not cover an injury sustained in the work[lace.
Sometimes it might be necessary to travel to see a physician: for example, when an injured worker needs a specialist, and there are none in the immediate area; or when an accident happens in a small town or rural location, without access to the medical services needed. If you are required to travel outside the local metropolitan area of the employer's location, then the employer is required to pay your travel costs: these are considered necessary and reasonable expenses. If you cannot travel, or believe that the travel is making your condition worse, speak to your employer/insurer about the situation. If nothing satisfactory can be worked out, at this point you can request a conference with an administrative law judge (ALJ) to discuss the situation. It might also be helpful to consult a Missouri Workers' Compensation Attorney.
If an injured worker is unhappy with the medical treatment he is receiving, or believes he needs a specialist, more tests, or a different type of treatment, these situations need to be handled carefully. First, discuss the issue with the insurance company. If this approach doesn't provide a solution, a workers' comp attorney can formally dispute the employer's treatment plan. On the other hand, if the insurer or employer disagrees with a doctor's diagnosis, they then have the qualified right to authorize a change of physician.