The new Illinois workers’ compensation laws include a pretty big change in how injured workers choose their doctors.
Under the old law, an injured worker was entitled to two choices of doctors. Each choice included any additional health care providers that your doctor referred you to (surgeons, specialists, therapists). This is known as a chain of referrals, and you were entitled to two chains.
You still technically get two chains of referrals, but there is a catch. The new law allows employers to set up preferred provider networks, which is basically a list of doctors you have to choose from.
You can opt out. The law says you are entitled to reject the preferred providers of your employer, but there is a penalty. If you opt out of the network, you only get ONE choice of doctor. Opting out of the network costs you one of your picks. Your one choice still includes that doctor’s referrals, but that’s it.
So the new law limits the doctors available to you, and restricts your ability to change doctors. Employers aren’t required to have preferred provider networks, but they certainly have incentive to enroll in the program – it saves them (and their insurance company) money to have contracts with select doctors.
Like most of the recent changes in the workers’ comp laws, this one helps businesses and insurers and hurts injured workers. Having two choices is important because not every doctor-patient match is a good one. If it becomes clear that they aren’t the right doctor for you, you might not have any recourse.
Some exceptions to the rule: If your injury requires a specialist that is not available in your employer’s preferred provider network, you may be able to argue for an exception. Also, the workers’ compensation commission can approve a third choice of doctors if you file a petition and can show that the treatment you are receiving in-network is improper or inadequate.
The bottom line is that if your employer has a preferred provider network, you will have a list of doctors to choose from. If you choose to go outside of the network, it counts as one of your choices, and you will have only one left. So be careful in order to avoid getting stuck with a bunch of medical bills.
We are workers’ compensation attorneys that help people with Illinois work injuries anywhere in IL via our statewide network of attorneys. Contact us and we will answer your questions or find the right lawyer for your situation.