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How Medical Conflicts of Interest Impact Your Workers’ Compensation Claim In Denver

Mark A. Simon Feb. 11, 2016

If you’re injured on the job, it’s natural to want to be seen and treated by your own doctor. But if you’re filing a workers’ compensation claim in Denver, a doctor approved by your employer’s insurance company must be the one to handle your claim, and ultimately their medical opinion—over your own doctor’s—is the one that matters. As you can imagine, this can create some pretty sticky conflicts of interest. When you’re faced with a workers’ comp claim and getting subsequent evaluation and treatment, here are a few scenarios you may encounter:

  1. Financial motivation. A doctor handling workers’ comp claims is getting paid for this service, and may be doing it as a way to supplement their income. So it behooves the doctor to stay in the good graces of their employer—in this case, the insurance company—by agreeing with the insurance adjuster and not with your claim. Disagreeing with the insurance adjuster too many times puts the doctor’s job at risk: they could be removed from the list of approved doctors and therefore lose that income.

  2. Lack of current education and/or relevant experience. Because many workers’ comp doctors handle these claims on the side, some don’t have the incentive to keep up with the latest medical literature, studies, necessary certifications, or education needed for this role. A doctor evaluating a torn ligament injury, for example, may not even have prior experience in orthopedic medicine. If you suspect your workers’ comp doctor is not handling your claim correctly or lacks relevant experience, you’re entitled to a second opinion.

  3. Money-saving tactics. Insurance companies prefer not to spend money on diagnostics and therapeutic services, not only because they’re expensive, but because they introduce more complexity into the claim. Workers’ comp doctors know this. As a result, they may avoid telling you about a test or service that could be beneficial to you, and instead treat your injury with pain medication, which is less expensive. And while some pain medication may be necessary, it’s not a fix.

  4. Personal interest. Conversely, some workers’ comp doctors may have a personal or financial interest in a facility where diagnostics are performed. So the doctor may order tests at a particular facility that the insurance company later refuses to pay for because the tests were deemed unnecessary and therefore not approved. Unfortunately, the burden of payment then falls to you. While many doctors are careful to seek approval from insurance companies before tests are ordered, you should always double-check to make sure your insurance will cover what the doctor is recommending.

It’s important to note that there are many workers’ comp doctors who have your best interests in mind and perform honest evaluations. But whenever an insurance company is involved, whose goal is to save money, a conflict of interest is likely.

For more information about workers’ compensation in Colorado, including medical care, check out these FAQs.

If you have a workers’ compensation claim and need help understanding your rights or finding appropriate medical care, contact Denver workers’ compensation attorney Mark A. Simon. He can guide you through the process to economic and physical recovery. Call today for a free consultation.