Know Your Rights: Choose a Doctor for Your L&I Claim or Workers’ Compensation Claim

In Washington State, work injury claimants have the right to choose their doctor or attending provider (AP) for their claim. This right is part of RCW 51.36.010. Surprisingly, many people that suffer a workplace injury don’t know that they can select their own doctor. Yet, the only requirement is that the doctor or the provider must be part of the L&I Medical Provider Network (MPN).

L&I claim and your right to choose a doctor

There are many reasons for which people with an L&I claim or a workers’ compensation claim are unaware of their rights. Explicitly, the main reasons I see include:

• Not understanding how a workers’ compensation claim works. Most people never had a L&I claim They don’t know what an attending provider is, or what is their role. In fact, the attending provider has a very important role in L&I claims. This provider manages treatment, reports progress, and provides critical assessments throughout the claim. Therefore, it’s important for work injury claimants to choose a doctor or provider who will help them recover and manage their claim productively.

• Not realizing how a provider becomes their attending physician. Often, the Department of Labor and Industries (L&I) considers the provider that filed the application for benefits as the attending physician. If that provider is an urgent care provider, it’s unlikely they’ll agree to be the attending provider on the workers’ comp claim. If you had a workplace injury and treated in emergency setting, you should seek follow-up care from another doctor that will be an effective AP.

Making your own decisions in your L&I claim

In addition to the reasons above, there are other cases where work injury victims follow recommendations from others. In practice, many recommendations don’t help you choose the right provider for your claim. Such cases include:

• Being directed to a specific clinic or medical provider. Frequently, work injury claimants tell me their employer told them to see a specific doctor for initial treatment. Then, when they report their injury back at work, the employer provides the name and address of a specific medical provider or clinic for further treatment. Here, claimants are usually under the impression they can only see that provider.

• Getting referral to occupational medicine doctors from a primary care physician (PCP). Some people ask their primary care doctor for guidance after a work injury. Some PCPs are members of the MPN and can easily become the attending provider. Often, this is an ideal situation. However, when the PCP is part of a large medical group, the work injury claimant gets a referral to the “occupational medicine” division of the same group. These groups are often a L&I COHE. This practice is common at The Everett Clinic and Kaiser Permanente, among others. Yet, many folks with an L&I claim or a workers’ comp claim don’t realize they don’t have to get treatment there. Regardless of insurance, workplace injury claimants can treat with any provider in the MPN. Even if the attending doctor isn’t part of the same medical group as their primary doctor.

Changing a doctor in your L&I claim

There is no doubt that the attending provider has a critical role in a workman’s compensation claim. One key right is the ability to choose the doctor for your claim. Moreover, with some narrow exceptions, you also have the right to change the doctor for an L&I claim. Changing the attending provider is very simple. More explicitly, you can download and fill the Transfer of Care form (from the L&I website) and send it to your claim manager. As always, keep a record of all communications. This way, you can track and document your decision to designate a new provider.

Final remarks

In summary, the attending provider plays a very important role in workers’ compensation claims. And remember – people with a work injury claim have the right to choose their attending provider. Therefore, it’s important to choose a physician that’s going to focus on helping you get better and will help move the claim forward productively. Finally, if your attending physician isn’t right for you, then you have the right to switch to a different provider.

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