In an emergency, get medical treatment at the closest hospital immediately. In non-emergency situations, select one provider from the designated provider list given to you by your employer
Which Doctor Should You See?
Your employer must give you a list of up to four doctors or clinics. This is known as a “designated provider list." You must choose to see one of the providers on the list. If your employer does not provide you with the written list within seven business days of you notifying your employer about your injury, you may choose your own doctor. If you receive the written list, you should keep a copy of the list along with any other claim related documents.
What is an Authorized Treating Physician?
An Authorized Treating Physician (ATP) is the doctor you have chosen from the designated provider list given to you by your employer when reporting the accident.
Appointments During Work Hours
You are encouraged to work with your employer to find the best time to schedule your appointments. If you miss time from work due to appointments, keep track of your hours. You can submit the hours you missed from work to your adjuster as you may be entitled to lost wage benefits for time missed from work to attend medical appointments.
Visits With Other Healthcare Providers
One of your first three visits at the ATP's office must be with the ATP. Your ATP may refer you to other doctors or specialists. Although you may be seen by another specialist, the supervising doctor will review and be responsible for your treatment.
What Do MMI and Impairment Rating Mean?
Maximum Medical Improvement (MMI) is a point in your claim when no additional treatment will help improve your condition. The doctor may recommend maintenance treatment to keep you at your current condition. If your doctor believes that the injury has resulted in long-lasting (permanent) impairment, your doctor will provide a rating of the impairment or refer you to another doctor who will. An impairment is a loss of function of any body part or body system. You do not need to be disabled to have an impairment.
What if Your Claim Is Denied for Further Investigation? Is Your Treatment Covered?
The adjuster may need additional information in order to determine whether your claim is compensable. Contact your adjuster to find out if treatment will be covered until a final determination is made.
Nurse Case Manager
The adjuster may assign a Nurse Case Manager (NCM) to your claim. The NCM’s involvement in your claim may include attending your appointments. You may decline the NCM’s services, and decide whether or not you want the NCM in the room during your appointments.
Changing Your Doctor
There are multiple ways to change your doctor. The process you may choose depends on when you want to make the change.
IMEs vs. DIMEs
IME stands for an “Independent Medical Examination." An IME is a second medical opinion. If respondents send you a letter scheduling an IME appointment, you must attend the appointment. An IME requested by the respondents will be audio recorded.
DIME stands for “Division (of Workers’ Compensation) Independent Medical Examination." Either party can request a DIME, and the requesting party pays for the DIME.