Have you been injured at work? One of the first questions you might have is whether you can choose your own WorkCover doctor or if this is decided for you. The short answer is yes; you have the right to choose your own doctor, and this choice matters more than you might think. They’re not only important for your recovery, but your chosen doctor is also key to the success of your compensation claim.
This quick guide outlines important considerations when choosing your WorkCover doctor and your rights during the process. We’ll also discuss what happens if WorkCover Queensland requests their own independent medical examination.
Your rights when choosing your treating doctor
For most WorkCover Queensland claims, you have the right to choose your own treating doctor. This is the general practitioner and the specialist responsible for your ongoing care, certifying the injury, recommending treatment, and providing a work capacity certificate.
A work capacity certificate is a medical certificate that covers what work-related injury or illness you have, the treatment you need, and whether you need time off work, and in certain cases what restrictions should be in place for you to return to work. Before you make your claim, you will need to provide WorkCover Queensland with a work capacity certificate from your doctor.
As well as providing this key first piece of documentation, your doctor plays a key role in:
- assessing your injury and providing the best recovery pathway
- documenting your injury, and what was the cause of the injury
- determining your working capacity
- managing referrals to make sure you get the best care, and rehabilitation possible.
Alongside your lawyer, your doctor is one of your biggest advocates when pursuing a WorkCover claim so it’s important you’re comfortable and happy with them. While you have the right to choose your own treating doctor, the insurer may request an independent medical exam (IME) to help review your claim or to provide a second opinion along the way.
Tips for choosing your WorkCover doctor
You can see any general practitioner for a work-related injury claim, however some are more experienced with WorkCover Queensland claims. The documentation and details they provide in assessments is a key piece of evidence for your case. You should choose a professional who is experienced in WorkCover cases and handling the process of returning to work. It’s not just about fair compensation; it’s also about your recovery and setting yourself up for success. In circumstances where you have a longstanding relationship with your regular general practitioner, he or she is often the best place to start, and to thereafter seek any referrals recommended.
How to find a doctor experienced in WorkCover claims:
- Ask your regular GP if they can assist with your work injury.
- Check if a general practitioner or clinic lists WorkCover as a specialty.
- As your current general practitioner (if they cannot) if they know anyone.
A general practitioner that is trusted in work-related injury cases will lower the risk of your case being disputed or denied. They also understand the complexities of return-to-work plans, how to navigate employers, and how to deal with the insurer. They should be your advocate with the insurer to ensure the best treatment outcomes.
If your regular general practitioner can provide the right level of support for your injury, this can be a great option. They know your health history which can give them important context, you know they are reliable, and you’re comfortable with them already. Have an open conversation with them about whether they can provide the right level of support for a WorkCover Queensland claim.
What if I want to change my treating doctor during a claim?
If you determine that your nominated doctor is not providing the right documentation or support, you can change to another doctor. This should be properly managed to avoid any disruptions to the progress of your recovery. It would only be in special circumstances that you might seek to change doctors.
You’ll need to inform both the insurer and employer involved in the case and provide a medical certificate from your new doctor. Make sure all your medical records and documentation is transferred for claim and treatment continuity. If this process is not done properly, there may be a gap in weekly benefit payments.
If you simply want a second opinion at any point during your claim process, you don’t have to change doctors. You can talk to a doctor that isn’t your WorkCover doctor and request your medical records to be shared with them.
Do specialist referrals need to be approved?
If your treating doctor refers you to a specialist, the referral and then any resulting treatment recommended must be approved by WorkCover Queensland before the consultation to confirm payment. For your treatment to be approved, the insurer will consider your injury, the recommended course of treatment and then, it must be confirmed as “reasonable and necessary”. At times, WorkCover Queensland may also request an independent medical examination to get an objective opinion to confirm the course of treatment recommended.
What if WorkCover Queensland send you their own doctor?
WorkCover Queensland may request that you see a doctor selected by them for an independent medical examination. This does not replace your treating doctor as their role is to provide an objective assessment of your injury or condition for the purpose of assisting the insurer in the management of your claim—not to provide treatment and recovery advice. You can learn more about this is our article about what an independent medical examiner is.
What if WorkCover Queensland disputes your doctor’s recommendations?
If you’ve selected a doctor and WorkCover disputes their assessment, you have a few options. They may dispute your doctor’s advice about work capacity, determine that the suggested treatment isn’t “reasonable and necessary”, or may challenge the severity of your injury.
Seek legal advice to make sure your next step gives you the best chance of getting your claim back on track. A lawyer can identify whether it was possibly due to missing or vague medical information, or whether your case is not eligible for compensation. Depending on what your lawyer says, you may request that a decision be reviewed by your claims officers manager, request a review of WorkCover’s decision, by the Workers’ Compensation Regulator and delegated to the Office of Industrial Relations. If it’s not resolved there, it can be escalated to the Queensland Industrial Relations Commission (QIRC).
How you can get the most out of your WorkCover doctor
As we’ve mentioned, choosing a general practitioner that is experienced in compensation claims is a strong first step. Next, be honest and detailed when describing how and what caused your injury, your symptoms and how they are affecting your ability to work. You should also communicate consistently between your doctor and lawyer to make sure everyone is on the same page during your claim process. Finally, keep records of all certificates and medical reports so that you have a solid foundation of evidence.
As well as choosing the right doctor, it’s important that you seek legal advice during the process to protect your rights at every step. Get in touch with our experienced compensation lawyers for a free, no-obligation consultation.