Choice of Practitioner and Payment of Medical Expenses, Rejection of Treatment, and Examination by Employer/Insurer's Practitioner

An employee who is injured at work or suffers from an occupational disease, is entitled to payment of all medical, surgical and hospital treatment relating to the injury including: doctor bills, hospital bills, medicines, medical and surgical supplies, crutches and artificial limbs. In addition, an injured employee is entitled to travel expenses and. in certain circumstances, compensation for lost time incurred for treatment or examination.

All reasonable and necessary medical expenses must be paid by the employer, or by the insurance carrier, whether or not weekly benefits are also due for temporary or permanent disability.

Selection of a Practitioner/General Rule & Emergency Situations

When a worker reports an injury, the employer shall offer the worker the right to select a practitioner of the worker's choice for treatment. The employee may select any physician, psychologist, chiropractor, podiatries, dentist, physician assistant, or advanced practice nurse practitioner licensed to practice in Wisconsin. If the injury creates an emergency situation, the employer may make whatever arrangements are necessary for immediate treatment but once the emergency passes, the worker has the right to select a practitioner for future treatment. Also, in an emergency situation, where it is not practical for the employee to give notice to the employer, an employee can go to any doctor for treatment, but the employer should be notified as soon as possible thereafter.

Choice of Doctor and Payment of Medical Expenses Reference: Wisconsin Statutes 102.42(2) and Wisconsin Statutes 102.42(3)

Employee Allowed First And Second Choice Of Practitioner

The law recognizes that if the employee does not have confidence in the first practitioner, recovery may be delayed. If the employee is not satisfied with the first practitioner s/he chooses, a second choice is allowed. While the worker must notify the employer of this second choice,neither the insurance company nor the employer may object to it.

After changing practitioner once, any further change may be made only by mutual agreement between the employee and employer/ insurance carrier. If the attending practitioner refers the employee to a specialist or a series of specialists, or to another practitioner, this referral is still considered to be treatment by one practitioner. If several practitioners in one partnership or clinic are seen, these are all considered one doctor.

Failure to notify the insurance company and/or the employer of the initial selection or of a change of doctors may lead to a disputed claim and the possibility of the injured employee having to pay for the entire cost of treatment.

Out of State Treatment

The employee may treat with a medical practitioner not licensed in Wisconsin, with the consent of the insurer and/or employer.. Consent of the insurer or employer is not necessary if the out-of-state treatment is based on a referral from a practitioner licensed in Wisconsin.

 

Examination by Employer's Practitioner

On written request, which contains proper notice and prepayment of certain costs, wan employee should submit promptly to a reasonable examination by any doctor (physician, chiropractor, psychologist or podiatrist) named by the employer or insurance company. Independent Medical Examination

Refusal of Treatment

No compensation is payable for disability of an employee if the disability was caused by, or aggravated by, or is continued by, an unreasonable refusal or neglect to submit to or follow reasonable medical or surgical treatment. However, an employee may refuse any invasive procedure, including surgery, which might endanger life or limb.

Reference: Wisconsin Statutes 102.42(2), (3). & (6) and Wisconsin Statutes 102.13

 

 

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