When you’re injured at work and need to file a workers’ compensation claim, it’s likely that you’ll need to see a doctor first. But, whose doctor should you see – yours or theirs – and what should you look out for? We asked Charles Surrano, an Arizona attorney and member of the Advocate Law Group network with 30 years experience who specializes in bad faith litigation, workers’ compensation and disability claims against insurance companies, to provide some answers. Here’s what he had to say:

May injured workers use their own doctors or do they have to use the insurance company’s doctors?

No, a claimant has a right to basically select his doctor once it’s been determined that he’s entitled to receive medical treatment. Insurance companies will often have their own doctors or clinics that they want to send people to and they’ll do that at the beginning. However, you can always request a change of physician.

Do injured workers have to pay for doctor’s visits out of their own pockets?

No. That’s the whole purpose of workers’ compensation – to provide an immediate remedy without question of fault to an injured worker. It basically supplants the whole idea of fault based damages where the injured worker would have to sue the employer for negligence. That’s what’s so frustrating about workers’ compensation visa via the bad faith laws. The whole intent behind workers’ compensation is to provide workers with an expedited, streamlined and efficient remedy to get them the benefits they need when they get injured without entangling them and holding up the benefits they need in what would otherwise be a more contracted litigation process.

So, when the insurance company denies claims without investigation, delays payment of claims and acts in ways which are contrary to the duty of good faith and fair dealing, they’re basically contravening the very impetus behind the entire workers’ compensation scheme. They’re thwarting the whole system. It becomes a perversion of what it was intended to be.

What are some of the reasons that benefits are denied?

The short answer to that is – sometimes, there is no reason. For example, I’ve said many times that you see insurance companies that simply deny claims with no investigation. What’s the reason for denying a claim without an investigation? I guess the reason is – because you can. If nobody does anything about it, they’ll keep doing it. However, the simple fact is that they were supposed to have done an adequate investigation before they deny a claim. Other reasons include searching for pretexts upon which to deny a claim even after you’ve accepted it. You can do that by hiring biased medical examiners, for example. That’s a fairly well known tactic.

If the insurance company knows that they’ll be on the hook for a claim because doctors have determined that the injured worker needs expensive treatment, insurance companies have been known to hire ‘Mr. I’m in Your Pocket Doctor’ to do an examination. He gives them an opinion they like and then they deny the claim. After that, they’ll litigate it and drag the process out. The worst case scenario for insurers is when the case stays in the Industrial Commission as they’ll simply have to pay what was owed in the first place. The best case scenario is when they win and don’t have to pay anything. They save a bunch of money.

Bad medicine

Although it does not happen frequently, claimants can sue doctors that conspire with insurance companies to deny claims. We asked Surrano what he thought about this and he told us, “Actually, I’ve done that. You don’t see it happen frequently, but in my opinion, doctors – upon the right theory of liability – can be held responsible for providing aid and assistance to an insurance company that is knowingly denying a valid claim.”

“If the doctor and the insurance company – for lack of a better term – ‘conspire’ to help meet the same objective of getting rid of a claimant who has valid injuries, they both should be held accountable and the law says they can be. There are doctors like that; they make it known that they’re out there to help the insurance companies.”