Who can I choose as my doctor under the Defense Base Act? March 15, 2009Posted by Aaron Walter in Uncategorized.
Tags: choice of physician, medical treatment, nurse case manager
This is a question I am not asked frequently enough. The answer is simple – under the Defense Base Act you can choose any qualified physician under the sun to treat your injuries. That is a flexibility not offered under most state workers’ compensation systems. For instance, in the State of Georgia, where our office is located, you would only have a choice from a list of doctors your employer posts at your work place. Under the Defense Base Act, depending on the type of injury you suffered, if the doctor you choose is a licensed surgeon, podiatrist, dentist, clinical psychologist, optometrist, osteopath, or chiropractor, then you have made a valid initial choice of physician.
The reason why I am not asked this question very often, is that most injured contractors only contact an attorney AFTER something has gone wrong with their case, like that their benefits are stopped or reduced or a medical procedure is denied or delayed. One reason why this is unfortunate is that while you have amazing flexibility in choosing an initial physician, those same rules limit your ability to change doctors.
If your first choice of physician refers you to some other specialist, for instance a family doctor who refers you to a orthopedic specialist for a back problem, the insurance company must honor that referral. Also, if your doctor retires, you can choose a new one.
However, outside of those situations, you are pretty much stuck with your first choice. Once a claimant has made his initial, “free choice” of a physicians, he may change physicians only upon obtaining prior written approval of the employer, insurer, or the Department of Labor. It is likely that if you do not like your doctor or what he is telling you, the insurance company probably loves him.
One situation we have run into recently, is where the insurance company actually recommends a doctor to the injured employee. Sometimes this is done by the insurance company’s “Nurse Case Manager.” A Nurse Case Manager often just ends up being a spy for the insurance company. He or she will be assigned to your case and theoretically their job is to facilitate your medical treatment. They may even convince you to allow them to come to your doctor’s visits and speak privately with your doctor. However, no matter how pleasant a human being they appear to be, they are first and foremost an employee of the insurance company. Their paycheck comes from the same place as your weekly check and your medical expenses. Their interests are not necessarily in line with yours.
In a recent case, the Nurse Case Manager mentioned this “great” doctor they knew whose office was nearby to our client. Little did he know that this doctor is one of the “go-to” doctors one major insurer sends claimants to for ”independent” medical evaluations when they seek to challenge a claimant’s case. To our industry, this conversation is the equivalent of offering to sell you some beachfront property in Nevada.
They managed to fool the unsuspecting injured contractor into picking this doctor as his one free choice of doctors. You can guess how well that has worked out for him. He had no clue of this doctor’s reputation and had no clue he likely could not change doctors without the insurance company agreeing. While you have a wealth of options available to you upon your return to the United States or your home country, when you pick your doctor please do some research, talk to friends, or make some calls. Don’t just pick them out of the phone book and double check anyone the insurance company recommends.