After a Work Injury, Who’s Your Doctor?

If you get injured in a car accident, or while playing basketball, or if you are suffering from an illness, you will likely go to either an emergency room or your own doctor to take care of you. Other than network limitations from your health insurer that may limit your choices if you want the full benefits of your coverage, you have the right to be treated by whomever you choose.

Employer Gets to Make the First Choice

If you are injured on the job, however, things aren’t that simple. Under New Mexico’s workers’ compensation system, your employer gets a say in who your doctor will be. Putting aside true emergency situations, if you’ve been injured at work, your employer or its workers’ compensation insurer has the right to decide whether to direct you to see a doctor of their choosing or allow you to pick your own health care provider.

In the event that the employer selects the doctor, and you wish to change to your physician or another provider, you may do so after 60 days or more of treatment. However, it is important to advise your employer that you are electing to exercise that right by sending them a Notice of Change of Health Care Provider form. Three days after the insurance company receives the notice, if the claim representative has not objected, the worker may start treatment with the new health care provider. The new provider will be the authorized treating provider for the rest of the claim.

On the other hand, if your employer or its insurer advises you to pick your own doctor, you may and should do so and they will be responsible for all reasonable, necessary and causally related treatment. However, the employer or claims representative then gets the right after 60 days of treatment to require you to change to a doctor of their choosing. If you wish to stay with your own doctor at that point, you may do so, but you will be on the hook for any bills from your doctor from that point forward. You can object to the requested change by filing an objection within three days of receiving a Notice of Change from your employer directing you to see a new doctor. A hearing before a workers’ compensation judge will be scheduled and held within 7 days of the filing of the objection.

Employer Failure to Give Direction

Many times, an employee will get injured on the job and the employer will fail to give them any instruction as to whether they want the employee to go to a doctor of their choice or one you pick. In that case, you are free to make your own choice and your employer or its insurer will have to pay for the first 60 days of treatment. Make sure your doctor knows that this is a workers’ compensation claim and that the doctor should bill your insurer or self-insurance program, not your health insurance. After learning that you’ve selected your own doctor, your employer may tell you after 60 days that you will have to change to another doctor, but if the employer has failed to tell you anything, you might not have to change. You should consult with an experienced workers’ compensation attorney to discuss your options.

The Law Offices of Jeffrey C. Brown: Fighting for New Mexico Workers

We know how hard you work, and we’ll work just as hard for you. Call the Law Offices of Jeffrey C. Brown & Derek Thompson today at (505) 275-6600 or fill out our online form to arrange for your free initial consultation to discuss your workers’ compensation matter. We look forward to helping you get back on your feet, and back to work.

This website has been prepared by the Law Offices of Jeffrey C. Brown for informational purposes only and does not, and is not intended to, constitute legal advice. The information is not provided in the course of an attorney-client relationship and is not intended to substitute for legal advice from an attorney licensed in your jurisdiction.