Can Workers’ Comp Force Me to See Their Doctor?

You choose who treats your work-related injuries from a list of physicians approved by the Texas Department of Insurance (TDI). You can switch doctors with some limitations. But during the claims process, the TDI may schedule an independent medical exam (IME) with a doctor they approved. They’re in private practice and not employed by the TDI, but it pays them to examine you and give their opinion. You’re free to refuse, but your claim will be denied.

Can I Choose My Doctor?

Yes, with limits, you decide who’ll treat your work-related injury. Under Texas statute, 

• Unless there’s an emergency, the TDI requires those filing comp claims to receive medical treatment from a list of doctors that they approved
• You’re entitled to treatment by a doctor of your choice, though TDI narrows down the potential physicians to choose from
• That doctor can perform services within the scope of their practice
• If you’re unhappy with the doctor, you can contact TDI in writing (you can call if there’s a medical necessity) and request another. But you can’t switch physicians to “Doc shop” to get an impairment rating or medical report more to your liking

Ideally, you should call our office before making this choice. We can suggest doctors we’re familiar with and who deserve your trust.

Why Would Workers’ Comp Want Me to See a Doctor?

State law also requires you to see the next available doctor on this list when the parties dispute the impairment rating given by your doctor:

• This physician, after their IME, is required to issue a written report to the TDI
• Its findings will be presumed to be accurate. The TDI will base your impairment rating on that report unless “the preponderance of the other medical evidence is to the contrary.”  If so, an impairment rating from another doctor (which could be your doctor or a doctor hired by the insurance company to perform an IME) will be used  

Are you “forced” to go to this exam? Only if you want your benefits claim to go forward. No cooperating will result in the denial of your claim.

How Can I Make the Best of the Situation?

The TDI will send instructions to the physician stating the issues to be addressed and what needs resolution. We’ll get a copy of that, and if there are any factual errors, we’ll contact the TDI to make sure the physician has the facts straight before seeing you. We’ll also discuss with you what this doctor will likely focus on so you can be prepared.

Though the doctor should have a complete copy of your relevant medical records, you should still be familiar with your treatments and findings if asked about them. If you’re not sure, refer the doctor to the records.

The physician will probably ask you about the accident or situation that caused your injury or illness. The doctor may want to ensure your condition is work-related, and the details of what happened may help determine your diagnosis and level of impairment. Be honest, keep your answers short, and if you don’t know or can’t remember something – say that. 

The doctor will probably ask about your limitations and if they improved, by how much. Don’t lie or exaggerate. Tell the truth as best you can. Giving specific examples of what you can and can’t do and your difficulties with particular tasks may be helpful. 

You may be asked to describe your pain on a scale of one to ten. Explain what you feel as best you can and how it limits your abilities. For example, a knee injury may not be so painful you can’t walk across a room, but it may prevent you from walking down the street.

An issue an IME may focus on could be a past or current injury. The insurance company may claim you’re trying to collect benefits for problems not caused at work. A compensable injury includes one that existed before coming to work but was made worse on the job. Do your best to explain your condition as it existed before aggravating it and how much worse it is as a result.

What Shouldn’t I Do and Not Do at an IME?

Dress and present yourself in a way that’s consistent with your injury. If you have a foot injury, don’t wear high heels. If you need a cane or crutches, use them and bring them to the appointment. You could talk about how these devices help you and how you’re impacted if you don’t use them.

You should show up early and cooperate with the exam. Don’t treat the doctor like the enemy. The doctor may or may not create a report backing you 100%, but these physicians are professionals doing their job. 

Respect them and their time. They’re not there to hear you complain about the insurance company or your employer. If you have a hostile or combative attitude, that will be in the report and will not help your case.

Schechter, Shaffer & Harris, LLP Helps Those Injured at Work

Our attorneys have many years of experience helping those injured at work or those suffering illnesses due to working conditions. Call us at 713-893-0971, and we’ll evaluate your case during a free consultation.