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Saturday, April 19, 2014

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Seeking Medical Care

Seek Medical Care and Inform Your Supervisor or Employer of Your Injury:

  • In an emergency, seek immediate medical care at the nearest emergency room. Notify the health care provider that your injury is a workers' compensation injury and also notify your supervisor or employer as soon as possible that an injury occurred.
  • In all other instances, notify your employer that you have been injured before seeking any medical care (see Where to Seek Care section below). All injuries, no matter how small, should be reported to your employer.

By informing the health care provider that the injury is a workers' compensation injury, the necessary medical records can be forwarded to us right away. The earlier we receive medical records, the earlier we can make a determination on the claim.

WSI encourages your employer to go along with you when you seek medical care. While your employer does not necessarily have the right to be present in the examining room during your exam, your employer will benefit by going along because he or she will better understand any work restrictions recommended by the doctor - which enables your employer to provide a safe return to work for you.

Where to Seek Care:

If the injury is an emergency, you can seek treatment from any doctor.

If your injury is not an emergency:

  • If your employer has a designated medical provider to care for employees, you are required to see that provider for medical care (this applies unless you had previously informed your employer, in writing, of a different medical provider selection before any injury occurred). If you do not see your employer's designated medical provider or the different medical provider selection you may have chosen before an injury occurred, and you choose your own medical provider at the time of your injury, it may result in nonpayment of medical benefits and/or claim denial and you will be liable for the medical costs.
  • If your employer does not have a designated medical provider in place, you may seek treatment from the medical provider of your choice.

If You Want to Change to a Different Doctor:

If your doctor refers you to another doctor for consultation or treatment, you do not need written authorization from WSI. However, if you wish to change to a different doctor, please review the following steps:

  • If your employer has a designated medical provider (DMP) to care for employees, and you saw that provider for treatment (if you did not choose your own medical provider and notify your employer, in writing, of your selection before any injury occurred), you must receive care from that medical provider for 30 days before you can make a medical provider change. After 30 days, you must request written authorization from WSI. Complete the Change of Doctor form (C6) and mail it to us. We will make a decision on your request quickly, and we will notify you, and both doctors, promptly of the decision. It is your responsibility to inform your employer of your new medical provider. Please contact us to request a Change of Doctor form (C6).
  • If your employer does not have a designated medical provider, you must request written authorization from WSI. Complete the Change of Doctor form (C6) and mail it to us. We will make a decision on your request quickly, and we will notify you, and both doctors, promptly of the decision. Please contact us to request a Change of Doctor form (C6).

WSI's Request for You to Change Doctors:

WSI will monitor your medical treatment to make sure you are receiving quality and appropriate medical care for your injury. When warranted, WSI may require you to change doctors or transfer care.

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