Combating Doctor Shopping by Employers & Insurers in Workers’ Compensation Cases

Recovering from a serious injury is a tough challenge under any circumstances.

But if your accident occurred at work, that adds a whole extra layer of complexity. Workplace injuries and occupational diseases typically qualify for workers’ compensation benefits, but those benefits vary based on the state you live in.

Obtaining your benefits can be a long and frustrating process. One complicating factor is that Missouri law gives your employer the right to choose the doctor who treats your injuries. These workers’ compensation physicians are supposed to focus on helping you recover, but since they are selected by your employer or insurer, conflicts of interest often arise. Employers – and their designated insurance companies – have a vested interest in minimizing the benefit you receive or denying your claims altogether. 

This can make it harder to obtain the treatment you need and the fair settlement you deserve. That’s why it’s highly recommended that you speak with a workers’ compensation attorney regarding your medical treatment and your case. 

At Van Camp Law Firm, our attorneys have extensive experience with the Missouri workers’ compensation process, from assisting with medical intake paperwork to working with judges, doctors and other attorneys. Your attorney will advise you on what information to provide to the workers’ comp physician and how to appeal a denial or unfair settlement offer. 

Why is doctor shopping a problem in workers’ compensation cases?

As noted above, Missouri workers’ compensation law lets employers choose the doctor who treats workplace injuries. Most employers designate the final selection to their insurance company. The employer may also direct the insurer to change physicians if they disagree with the first doctor’s diagnosis or treatment decisions. 

This legal arrangement has led to numerous instances of “doctor shopping” by employers and their insurers. Many insurance companies develop cozy relationships with workers’ compensation doctors and will often continue to authorize those doctors who provide the reports and findings favorable to their interests. They typically seek out doctors who will side with them in an evidentiary hearing, also known as a trial. This creates a system where workers’ compensation physicians may feel pressured to limit benefits, understate injuries or avoid costly treatments.

Why do workers’ comp doctors lie?

Sometimes workers’ comp doctors provide biased opinions because of financial incentives from insurance companies or pressure to minimize the severity of injuries. They may present these opinions as objective, but the reality is that the insurer’s goal is to save money, not maximize your recovery.

This can lead to a number of problems for injured workers: 

  • The doctor may minimize the extent of your injuries
  • Delays in getting tests such as an MRI or X-ray
  • Receiving less than the full amount of treatment or therapy you need
  • Having to return to work before you are ready
  • Receiving less than the full settlement that you qualify for

What role does the attorney play in a workers’ compensation case?

The process of receiving treatment and collecting benefits after a work injury is often a complex and frustrating experience.

An experienced workers’ compensation attorney will have in-depth knowledge of how the system works, from completing paperwork to doctor visits to negotiating against settlement offers. Your attorney will help you navigate the system to make sure you don’t get taken advantage of by employers, insurers and their chosen workers’ comp doctors. He or she will assist you with many aspects of your case, such as: 

  • Completing required documents
  • Gathering evidence to support your claims
  • Helping you obtain a second opinion if you feel the employer’s doctor has provided less than the medical care you need
  • Requesting a Hardship Hearing to challenge the Employer/Insurer’s doctor

What are the essential duties of an attorney in these cases? 

Your workers’ comp attorney will advise you on how to accurately complete forms and describe ongoing symptoms and limitations resulting from your injury. This is essential for preventing miscommunication between you, the doctor, and other medical staff. 

Above all, you must never lie, exaggerate, or minimize your condition when seeing a workers’ comp physician. To the best of your ability, always provide the doctor with accurate information about preexisting conditions, prior injuries, and medical history. Be completely truthful about how your workplace injury occurred and the extent of your injury. Don’t delay medical treatment, as this can make your condition worse and reduce your chance of a full recovery. 

Speak with your worker’s comp attorney about your medical appointments as they can guide you on what to expect, common issues that arise, and questions to ask during medical appointments. They will also prepare you for interactions with workers’ compensation physicians, ensuring that you don’t accidentally downplay your condition. Your attorney will also assist you with negotiating settlements and making sure you receive payments in a timely manner. 

When to Contact a Workers’ Comp Attorney

If you’ve suffered a workplace injury, there are three steps you must take immediately:

  • Notify your employer: Don’t wait! Speak up immediately.
  • Contact a workers’ compensation attorney.
  • Request medical treatment: Follow all doctors’ orders with respect to any surgery, medication, therapy or other treatments.

At Van Camp Law Firm, we will educate you on your rights as an injured worker. We handle all aspects of a claim and understand the importance that obtaining necessary medical care has to an employee to get them not just back to work, but back to living. If your employer or their work comp insurance carrier denies your claim or minimizes your injury, we will assist you with the process and fight through litigation and appeal. 

Our attorneys have almost a combined half century of legal experience. We’ll work closely with you to protect your rights at every step of the process. 
Give us a call at 573-644-7777 or contact us online to schedule a free consultation.

Frequently Asked Questions

Why do employers and insurers doctor shop in workers’ comp claims?
Employers and their insurance carriers have a direct financial incentive to minimize the benefits paid out on workers’ compensation claims. Because Missouri law grants employers the right to select the treating physician, many insurers cultivate ongoing relationships with doctors who consistently produce findings favorable to their interests, such as understating injury severity or recommending early return to work. Over time, this arrangement can create a system where workers’ comp physicians feel pressure to limit costly treatments or side with insurers during evidentiary hearings rather than advocating for the injured worker’s full recovery.

What if the company doctor says I can return to work too soon?
A premature return-to-work recommendation is one of the most common ways injured workers are shortchanged in the Missouri workers’ compensation system. If the employer’s chosen physician clears you before you are medically ready, returning to work can worsen your condition and significantly reduce your chances of a full recovery. A workers’ compensation attorney can help you challenge that determination, request a second medical opinion, or file for a Hardship Hearing to contest the insurer’s doctor and protect your right to the treatment you actually need.

Can I get a second opinion if I disagree with the employer’s doctor?
While Missouri workers’ compensation law gives employers authority over the initial physician selection, you are not without options if you believe the treating doctor is downplaying your injuries or withholding necessary care. An attorney can help you pursue a second medical opinion and use that independent evaluation to challenge the findings of the insurer’s doctor. At Van Camp Law Firm, workers’ compensation attorneys assist injured workers in obtaining independent evaluations and presenting that evidence during settlement negotiations or at hearings when the employer’s doctor has not provided the level of care the injury demands.

What should I bring to my consultation if I suspect doctor shopping?
When meeting with a workers’ compensation attorney, bringing thorough documentation of your medical care and claim history gives your attorney the clearest possible picture of what has happened and where your case stands. Useful items to gather include any paperwork related to your injury report, correspondence from your employer or their insurance company, medical records and treatment notes from the workers’ comp physician, any return-to-work orders you received, and records of tests or treatments that were requested but delayed or denied. The more documentation you can provide, the better positioned your attorney will be to identify signs of biased medical treatment and build a strategy to protect your rights.

What rights do I have if my treatment is delayed or denied?
Injured workers in Missouri have the right to challenge treatment delays and claim denials through the workers’ compensation system, including by requesting a Hardship Hearing to contest decisions made by the employer or insurer’s physician. You also have the right to legal representation throughout the entire process, from completing initial paperwork to appealing an unfavorable ruling. Van Camp Law Firm handles all aspects of workers’ compensation claims and will fight through litigation and appeal if an employer or insurer attempts to deny your claim or minimize your injury.

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