You have the right to choose your own doctor. That doctor, however, has to be part of the Department of Labor & Industries' Provider Network. Make sure when you see a doctor for treatment related to your workers' compensation claim that he or she is part of the Provider Network. If not, you will need to find another doctor.
Who can treat you? A medical doctor, osteopath, chiropractor, advance registered nurse practitioner (ARNP), psychiatrist, dentist, naturopath or podiatrist can act as your attending provider so long as he or she is part of the Department's Provider Network. You can also treat with a physical therapist, psychologist, occupational therapist or other such provider, but he or she cannot certify time loss compensation for you. The Department will not pay for acupuncture or visits with a mental health therapist (MSW).
You can receive treatment only for medical conditions related to your industrial injury or occupational disease claim. Sometimes the Department will allow limited treatment for an unrelated condition. You may receive "aid to recovery" treatment if the unrelated condition prevents treatment for the accepted condition. An example would be payment for medication for high blood pressure if that condition prevents surgery for the accepted condition under a claim.
Suppose you develop a new condition on your claim. You have a serious back injury, your life is turned upside down, and you develop depression. If your treating doctor says that a cause of your depression was your industrial injury, then depression should be allowed under your claim. The Department frequently denies the new condition, saying that it pre-existed or is unrelated. No reason is given; the Department can just issue an order denying a condition.
Treatment for your accepted conditions under the claim will continue so long as you continue to improve. The Department calls this "curative" treatment. Once treatment is no longer curative, further treatment is denied. Other terms used are "fixed and stable" or "maximum medical improvement." The Department or self-insured employer may move your claim toward closure when you are no longer getting better.
No treatment is covered after the date the claim is closed. If the closing order becomes "final and binding," meaning there was no protest within 60 days, then you must submit a reopening application. You will need to prove worsening or aggravation of your condition. If you cannot prove by medical opinion that your condition has measurably worsened since claim closure, your claims manager will deny your reopening application by order.
If you have had treatment denied or your reopening application denied, please call us. We would be glad to review your claim file. Remember that you only have 60 days from the date of any unfavorable order to take a written protest or appeal. Take action before it is too late.