The Right to Choose Your Own Worker’s Compensation Doctor in Wisconsin

Unlike most other states, the Wisconsin Worker’s Compensation Act provides injured workers in Wisconsin broad rights to choose their own treating practitioners after a work injury. Specifically, Wis. Stat. § 102.42(2) directs employers to “offer” to the injured worker “his or her choice of any physician, chiropractor, psychologist, dentist, physician assistant, advanced practice nurse prescriber, or podiatrist.” The employer must also pay the travel mileage for related medical treatment with that doctor.

Common Problems Relating to a Worker’s Choice of Practitioner Rights

Unfortunately, many Wisconsin employers either fail or refuse to inform workers of the right to choose their own doctor. While some employers innocently may be unaware of this right, others intentionally do not disclose so they can send as many of their workers as possible to a “directed care” program. A directed care program is a contractual arrangement between the employer and a healthcare provider whereby the employer will send their injured workers to that provider’s occupational health facilities for all treatment related to the work injury. While directed care plans may provide savings to employers, their doctors often release injured employees back to work before medically appropriate – or before an accurate diagnosis is made – because the goal of most of these plans is to get injured workers back on the job soon and inexpensively as possible.

The typical story worker’s compensation attorneys hear from workers is that following an injury, the employee is told by a supervisor or human resources staff that they must go to the directed care provider for the injury. The worker is then diagnosed by the directed care physician with a minor condition, such as strain, and is released to continue work the same or next day. If the worker does eventually see their primary care provider due to ongoing medical issues related to the work injury, that doctor regularly disagrees with the directed care provider regarding (a) how much time is needed off work to heal, and (b) necessary future treatment.

Another common issue is the directed care provider may prematurely consider a worker fully healed, which allows the worker’s compensation insurance company to cease covering any future treatment. If a worker goes to their own treating practitioner later on for additional treatment, or for a second opinion on the diagnosis, the insurer often resists covering the treatment cost by relying on the directed care doctor’s opinion that the worker is fully healed.

As the above examples illustrate, it is incredibly important for injured workers to know about and understand their right to see a practitioner of their choice immediately following an injury, or else potentially face their worker’s compensation claim being prematurely denied.

Limitations on Employees’ Rights to Choose Their Own Practitioner

There are several limits on an injured worker’s right to choose their own doctor:

  1. First, workers are entitled to their choice of up to two practitioners. Any practitioners beyond the first two must be agreed to by the employer.
  • Second, the worker’s chosen practitioners must be licensed to practice in Wisconsin. Treatment with an out-of-state doctor will only be covered if either the employer consents or if a Wisconsin practitioner directly refers the worker to the out-of-state doctor.
  • Third, in an emergency situation where the injured worker is unable to express their choice of practitioner (e.g. the employee is unconscious or unable to reliably make decisions due to traumatic injury) the employer can send the worker to an emergency medicine provider of their choice.
  • Finally, employers are only liable for the “reasonable and necessary” expenses related to treatment from a worker’s chosen practitioner. For example, the employer may refuse to pay for a Kenosha worker’s mileage to drive up to see their chosen doctor in Hudson if there are other alternative doctors of the same specialty within closer distances.

Contact Hawks Quindel with Questions Regarding Your Directed Care Plan or Right to Choose Your Own Doctor

If you have been sent to a directed care doctor and feel you may have been returned to work before medically appropriate, or if your personal doctor disagrees with your directed care doctor about the nature and extent of your work injury, contact Hawks Quindel’s experienced worker’s compensation attorneys for a free evaluation of your claim.

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Brandon Jubelirer