The Illinois Workers’ Compensation Act provides that an employer is liable to pay for medical services initially chosen by the employee and any subsequent provider of medical services in the chain of referrals. The employer is also liable to pay for all medical services provided by a second physician chosen by the employee and any subsequent provider of medical services in the chain of referrals.
However, the employee’s choice of a second physician may be limited in cases which the injury occurred on or after June 28, 2011. Depending on whether your employer has a preferred provider program (PPP) and whether you stay within that network may limit your ability to choose a second physician. A preferred provider program is a network of physicians or other medical providers from which the employee must choose if they elect to participate. The employer therefore has some control regarding where an injured employee seeks treatment.
For employers without a PPP, employees have a choice of medical providers limited to a maximum of two different choices along with any referrals from those two choices. For employers with a PPP, the employer must inform you in writing that such a program exists. You may elect to see up to two physicians from your employer’s PPP after a work-related injury, which your employer is responsible for the payment of all medical expenses and referrals from the PPP physician. If you elect in writing to decline the PPP after a report of injury, you are limited to the choice of only one physician.
In addition, if your employer has a PPP, but you choose non-emergency treatment from a provider not within the program prior to your report of injury, this too will constitute your choice of physician.
There is an exception which allows for injured workers who have received inadequate care by a physician from within the employer’s PPP. If the Commission finds that the employee was provided inadequate care, then the injured worker can choose a medical provider outside of the PPP.
While the legislation was designed to help employers control medical costs, it has limited the employee’s right to choose where they get treatment.
The attorneys at Law Offices of Mathys & Schneid are committed to representing people who have been seriously injured and incur significant medical expenses as a result of work injuries. Law Offices of Mathys & Schneid continue to handle workers’ compensation and personal injury cases in Cook, DuPage, Kane, Will and Kendall Counties and all throughout the Chicagoland area.