What is a Primary Treating Doctor?
 
A primary treating doctor is a doctor who is in charge of your treatment. He may
refer you to other doctors and get consultative reports or refer you to physical
therapy for treatment or send you out for x-rays or other diagnostic testing,
but it is the primary treating doctor who coordinates your treatment and
provides reports to your attorney and the insurance company.
How many primary treating doctors can I have?
You can only have one primary treating doctor at a time. However, you are
allowed to change primary treating doctors. You should only change for a good
reason. If your employer or their insurance company has selected your primary
treating doctor, it is a good idea to change to a doctor who is not under their
control. The report of the primary treating doctor has extra weight. The primary
treating doctor is "presumed" to be correct. That means that the judge is
expected to give great weight to the opinion of the primary treating doctor. If
another doctor has a different opinion but does not have a very impressive
argument for his opinion, the judge is required to believe the opinion of the
primary treating doctor. Therefore, it is to your advantage to have a treating
doctor who is on your side.
The primary treating doctor determines how long you receive treatment, how long
you stay out of work, whether you can return to your usual and customary
occupation, and the nature and extent of your permanent disability, if any. It
is very important to have a doctor who is not beholden to the insurance company
making these decisions.
One of the most important aspects of your workers' compensation case is "medical
control." If the insurance adjuster determines who your doctor is, they can call
the doctor and put pressure on him or her to release you to return to work even
though you may be still complaining of inability to work. You can obtain medical
control from the very beginning of a workers' compensation case if you
pre-designate your treating physician.
The law allows you to notify your employer, before you are injured, of the
doctor that you would like to be your primary treating doctor. This doctor must
have treated you in the past and have your medical records.
What is a Qualified Medical Evaluator (QME)?
If you have been treating for more than thirty days and you object to the
treating doctors findings or decision, you can select another doctor to be the
treating doctor. If you have been treating for more than thirty days and the
insurance company objects to the doctors opinions, they must contact your
attorney and try to agree on a different doctor to provide an opinion. If we do
not agree, then they can send you to a doctor of their choosing (a QME) solely
for an evaluation, not for treatment. As discussed above, the doctor's opinion
may not have as much weight as the treating doctors.
You cannot select a new treating doctor if the previous doctor has already
released you. In that case you must object to the treating doctor's opinion and
go to a Qualified Medical Examiner. This is a bad position to be in because then
the treating doctor has the presumption of correctness and the QME must overcome
that presumption by being more convincing to the judge than the treating doctor.
What is an Agreed Medical Evaluator (AME)?
Another option is to agree with the insurance company on a doctor who we both
believe is fair to give an impartial opinion of your condition.
If we agree on a doctor, we can challenge the opinion of that doctor but since
we have agreed to the doctor, the judge usually will give that doctor's opinion
great weight. Both sides are essentially stuck with that doctor's opinion. Your
attorney will only agree to a doctor which he believes to be fair. Obviously,
the insurance company will not agree to a doctor who they think is "too fair."
The problem with agreed doctors is generally that they are all so popular that
they cannot see you for several months and it often takes several months more
before they provide us with a report. The advantage is that we usually do not
have to go to trial on a case where we have agreed on a doctor because we settle
based on the opinion of that doctor. While your attorney may know many doctors
who are fair, each insurance company usually limits their adjusters and
attorneys to agreeing to only certain doctors.
If you have any questions about this, or any other issue of your workers'
compensation case, please call or write to your attorney's office.
© Robert S. Havens, 2005
This article is for general information, and not meant as
specific legal advice. You should always see an attorney for specific legal
questions.
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