Check Out Our Podcast: The Verdict
Who really chooses your doctor after a workplace injury—you or the insurance company?
In this episode of The Verdict, catastrophic injury attorney Clark Speaks and workers’ comp lawyer Brian Groesser unpack one of the most frustrating realities for injured workers: once the claim is accepted, the insurance carrier gets to call the shots on your medical care.
Brian explains how carriers maintain lists of “good” and “bad” doctors—good meaning those who minimize treatment, avoid surgery, and send employees back to work quickly. But what happens when you’re still in pain and the system says, “You’re fine”?
We’ll tell you how this affects both your physical recovery and your wage loss claim, and how injured workers can end up making their condition worse by returning to work too soon.
Here’s what we discuss in this episode:
0:00 – Medical care decisions
2:30 – Why it matters
5:25 – Working through pain
Workers comp, catastrophic injury, insurance claims, first 90 days, attorney
Learn more about how Speaks Law Firm can help you: https://www.speakslaw.com/
Schedule your FREE case review: https://www.speakslaw.com/our-team/r-clarke-speaks/#contactFormTarget
Find us on YouTube: https://bit.ly/3R40YMP
00:00
I'm Clark speaks, the catastrophic injury lawyer, welcome to the verdict. Hi. I'm Clark speaks, welcome back to the verdict. I'm here with Brian grocer, Brian to continue our conversation after a workplace accident, who controls what medical care and what doctors that an injured person goes to? This is often for an employee, the most frustrating aspect of workers comp is the lack of control, and as soon as the carrier decides that they're going to start paying for medical treatment, they call the shots. The statute 9725
00:32
allows them to direct medical care. So you may have an orthopedic that you like, or maybe you saw them with a prior injury or your family member treated with them. Doesn't matter. Maybe the carrier will say, okay, yeah, we'll go with them. But most likely, they're going to send you to a doctor, a specialist of some sort, eventually, once you get out of urgent care that they're familiar with that they have because the one thing that I talked about at the beginning when it comes to these carriers is to curb their exposure, to limit their exposure, and if they have a known doctor, a lot of these insurance carriers have lists in their office, good doctors, bad doctors, right? And they're not good doctors, bad doctors. By one is a quack and the other one's an expert surgeon. It's good doctors in the sense that this doctor tends to release people back to work full duty. This doctor assigns low ratings. This doctor doesn't necessarily believe workers comp patients are telling the truth. They're good doctors for the insurance carrier. The bad doctors are the ones that recommend surgery. Maybe they assign higher ratings. Maybe they're more hesitant to release an employee back to work. All these insurance carriers have that list, and they're becoming much more sophisticated now that AI exists and everything these lists are becoming much through the data to see what these doctors have done in the past, 100% right? If you're looking to curb your exposure, you want to have your known exposures, you don't want to send the second most important decision that an insurance carrier can make outside of accepting or denying your case, is which doctor to send you to, because at the end of the day, I said that the employee doesn't have control in terms of choosing the doctor, but as soon as the carrier puts you in the hands of a doctor, they kind of lose control too, because now you're in the hands of the doctor in terms of the doctor making recommendations, if they have a better idea as to what that doctor is, more likely to say they're going to send you to that doctor in terms of the one that's likely to return you back to work quicker, likely not going to recommend surgery and likely assign you a lesser rating. Okay, so if I'm an injured person, I mean, why does that matter to me? I probably don't want surgery anyway, as I'm sitting here talking about it right now, I'd rather not have a surgery. I'd rather go back to work. Why does that matter from the perspective of an injured person? Well, you know, you may not want to have surgery, but you may have to have surgery, right? That may be a situation where you do need surgery. You've got a herniated disc, and it ain't going to get any better without doing some sort of surgery, whether it's a decompression or a fusion. Or you may have a situation where you've got something in as an ans, carpal tunnel syndrome, right? And your hand just keeps getting numb, and you figure you can just get through it, but at the end of the day, it's not going to get any better. The only way that you can actually fix it is through surgery. And so you may not want to have it, but ultimately you may need to have it, and you would rather go see a doctor that'd be willing to perform it in order to make you better, rather than go to a doctor who's going to maybe side with not doing it simply because you're a worker's comp patient, and they typically get referrals from the workers comp carrier for patients. So they're getting paid by the insurance carrier, and maybe they're less they're more hesitant to recommend surgery as a result of that, because they know the carrier typically doesn't want to pay for a surgery if they don't have to, and so it's not a matter of wanting to have a surgery. It's matter of needing if you need it, you should go with a doctor that's willing to do it and do a good job with it. The other aspect of it is there's two components to your workers compensation. Case, we've been talking a lot about the medical side. The second component is the wage loss side, and that is why the insurance carrier is trying to return you back to work as quickly as possible, because that is typically their largest exposure. How long are you going to be out of work if a doctor is keeping you out of work out of precaution because they don't believe you're ready and you may injure yourself further if you go back to work too soon. That doesn't sit well with the carrier, because the carrier is paying weekly checks, and as each check goes out, they have to, sometimes even put more money into your case, what's called reserves. They may have to add to the reserves with each check that they keep paying. They want to limit those checks. They don't want to keep paying those checks if they don't have to. And so if they can send you to a doctor that is more likely to return you to work without restrictions, or return you to work with restrictions that they know the employer can accommodate, then they can cut those checks off. The problem is the workers comp world, even though it seems like maybe to the doctor, that you could go back to that job because of some generic description that the employer gave them, in reality, either the employer is not abiding by what they are saying they are going to do, from your restriction standpoint.
05:00
Or the job is much more involved than what the employer is telling the doctor that it is. And so those are things that happen all the time. There's always pushback in terms of return to work, and is this the accurate job, and is this something they're capable of doing? But keeping in mind that the carrier is always looking to facilitate that if they can, because it's a way for them to stop the second component of your claim, which is the wage loss portion. Let's look at a specific example. Okay, somebody is injured at work in a work related accident.
05:30
It's in the scope of employment. It's a shoulder.
05:36
The doctor says you
05:38
don't need a surgery, but your shoulder still bothers you, right, and you feel like it's not right, and so the doctor says you can go back to work now, in general, historically, most of our clients, in my experience, are sort of stoic. They're hardworking people. You know, nobody cares if you have a runny nose, if you have a headache, you still got to get up and go. You got to take care of your family. You got to go to work, even, even if you grew up playing sports or whatever, you know, you got to get back in the game. You got to get back on the field. So that's how we're all conditioned to do. I think, I think, and that's an admirable thing. That's good. But under these circumstances, if you go and you just work through that pain,
06:18
my experience is that
06:21
you might this pain is going to potentially get worse. Your condition is going to get worse, and it may really negatively impact your ability to provide for your family in the future, and at that point, it may be too late. Is that a practical consequence of this type of issue that comes up in workers compensation? Absolutely is, because, like, I've been this common theme all along, is that, as an attorney, we are looking to be your advocate. We are looking out for your best interests, right? And so I don't mind you going back to work. If you're my client, that's you got to put, you know, bread on the table for your family, if that. And you maybe don't want to sit around the house, right? You want to be doing something, be active. I don't mind you going back to work. I mind you going back to work when you are not physically ready to go back to work. And that's not something that necessarily the carrier cares about. They just care about you going back to work so they don't have to pay you the weekly check. And here's a dirty little secret when it comes to doctors, they're not trained about returning you back to work. That's not a class that they take in medical school. They're winging it too, like they are trying to kind of play it by ear and figure out if you're capable or not capable of going back to work. And if they've done workers comp for a long time, maybe they know how the system works, and they say, Well, you know he's He's fine, he'll be okay, but maybe you're not fine, right? Maybe they're just tired of treating you as a worker, treating workers comp patients, and they just want you out of the office and to go back to work because you're just sitting out because you want to collect checks in their mind. But that's not the reality. The reality is is that you are hurt and exactly what you described, you're trying to work through the pain, but you can make the thing worse, and you could be a liability to your own employer, in that sense, if your shoulder is still giving you pain, and you're working a machine or equipment and you don't do it right, you could be a danger to yourself or to others, and we just want to make sure that when you go back to work, you are physically ready to go back to work. Thank you, Brian, when we come back, I'd like to talk to you a little bit about what we can do to counter some of these positions taken by doctors under these circumstances. So join us in the next episode. Thanks for joining us. Don't forget to subscribe and follow us to stay up to date with our weekly episodes. We'll see you next time you.
00:00
I'm Clark speaks, the catastrophic injury lawyer, welcome to the verdict. Hi. I'm Clark speaks, welcome back to the verdict. I'm here with Brian grocer, Brian to continue our conversation after a workplace accident, who controls what medical care and what doctors that an injured person goes to? This is often for an employee, the most frustrating aspect of workers comp is the lack of control, and as soon as the carrier decides that they're going to start paying for medical treatment, they call the shots. The statute 9725
00:32
allows them to direct medical care. So you may have an orthopedic that you like, or maybe you saw them with a prior injury or your family member treated with them. Doesn't matter. Maybe the carrier will say, okay, yeah, we'll go with them. But most likely, they're going to send you to a doctor, a specialist of some sort, eventually, once you get out of urgent care that they're familiar with that they have because the one thing that I talked about at the beginning when it comes to these carriers is to curb their exposure, to limit their exposure, and if they have a known doctor, a lot of these insurance carriers have lists in their office, good doctors, bad doctors, right? And they're not good doctors, bad doctors. By one is a quack and the other one's an expert surgeon. It's good doctors in the sense that this doctor tends to release people back to work full duty. This doctor assigns low ratings. This doctor doesn't necessarily believe workers comp patients are telling the truth. They're good doctors for the insurance carrier. The bad doctors are the ones that recommend surgery. Maybe they assign higher ratings. Maybe they're more hesitant to release an employee back to work. All these insurance carriers have that list, and they're becoming much more sophisticated now that AI exists and everything these lists are becoming much through the data to see what these doctors have done in the past, 100% right? If you're looking to curb your exposure, you want to have your known exposures, you don't want to send the second most important decision that an insurance carrier can make outside of accepting or denying your case, is which doctor to send you to, because at the end of the day, I said that the employee doesn't have control in terms of choosing the doctor, but as soon as the carrier puts you in the hands of a doctor, they kind of lose control too, because now you're in the hands of the doctor in terms of the doctor making recommendations, if they have a better idea as to what that doctor is, more likely to say they're going to send you to that doctor in terms of the one that's likely to return you back to work quicker, likely not going to recommend surgery and likely assign you a lesser rating. Okay, so if I'm an injured person, I mean, why does that matter to me? I probably don't want surgery anyway, as I'm sitting here talking about it right now, I'd rather not have a surgery. I'd rather go back to work. Why does that matter from the perspective of an injured person? Well, you know, you may not want to have surgery, but you may have to have surgery, right? That may be a situation where you do need surgery. You've got a herniated disc, and it ain't going to get any better without doing some sort of surgery, whether it's a decompression or a fusion. Or you may have a situation where you've got something in as an ans, carpal tunnel syndrome, right? And your hand just keeps getting numb, and you figure you can just get through it, but at the end of the day, it's not going to get any better. The only way that you can actually fix it is through surgery. And so you may not want to have it, but ultimately you may need to have it, and you would rather go see a doctor that'd be willing to perform it in order to make you better, rather than go to a doctor who's going to maybe side with not doing it simply because you're a worker's comp patient, and they typically get referrals from the workers comp carrier for patients. So they're getting paid by the insurance carrier, and maybe they're less they're more hesitant to recommend surgery as a result of that, because they know the carrier typically doesn't want to pay for a surgery if they don't have to, and so it's not a matter of wanting to have a surgery. It's matter of needing if you need it, you should go with a doctor that's willing to do it and do a good job with it. The other aspect of it is there's two components to your workers compensation. Case, we've been talking a lot about the medical side. The second component is the wage loss side, and that is why the insurance carrier is trying to return you back to work as quickly as possible, because that is typically their largest exposure. How long are you going to be out of work if a doctor is keeping you out of work out of precaution because they don't believe you're ready and you may injure yourself further if you go back to work too soon. That doesn't sit well with the carrier, because the carrier is paying weekly checks, and as each check goes out, they have to, sometimes even put more money into your case, what's called reserves. They may have to add to the reserves with each check that they keep paying. They want to limit those checks. They don't want to keep paying those checks if they don't have to. And so if they can send you to a doctor that is more likely to return you to work without restrictions, or return you to work with restrictions that they know the employer can accommodate, then they can cut those checks off. The problem is the workers comp world, even though it seems like maybe to the doctor, that you could go back to that job because of some generic description that the employer gave them, in reality, either the employer is not abiding by what they are saying they are going to do, from your restriction standpoint.
05:00
Or the job is much more involved than what the employer is telling the doctor that it is. And so those are things that happen all the time. There's always pushback in terms of return to work, and is this the accurate job, and is this something they're capable of doing? But keeping in mind that the carrier is always looking to facilitate that if they can, because it's a way for them to stop the second component of your claim, which is the wage loss portion. Let's look at a specific example. Okay, somebody is injured at work in a work related accident.
05:30
It's in the scope of employment. It's a shoulder.
05:36
The doctor says you
05:38
don't need a surgery, but your shoulder still bothers you, right, and you feel like it's not right, and so the doctor says you can go back to work now, in general, historically, most of our clients, in my experience, are sort of stoic. They're hardworking people. You know, nobody cares if you have a runny nose, if you have a headache, you still got to get up and go. You got to take care of your family. You got to go to work, even, even if you grew up playing sports or whatever, you know, you got to get back in the game. You got to get back on the field. So that's how we're all conditioned to do. I think, I think, and that's an admirable thing. That's good. But under these circumstances, if you go and you just work through that pain,
06:18
my experience is that
06:21
you might this pain is going to potentially get worse. Your condition is going to get worse, and it may really negatively impact your ability to provide for your family in the future, and at that point, it may be too late. Is that a practical consequence of this type of issue that comes up in workers compensation? Absolutely is, because, like, I've been this common theme all along, is that, as an attorney, we are looking to be your advocate. We are looking out for your best interests, right? And so I don't mind you going back to work. If you're my client, that's you got to put, you know, bread on the table for your family, if that. And you maybe don't want to sit around the house, right? You want to be doing something, be active. I don't mind you going back to work. I mind you going back to work when you are not physically ready to go back to work. And that's not something that necessarily the carrier cares about. They just care about you going back to work so they don't have to pay you the weekly check. And here's a dirty little secret when it comes to doctors, they're not trained about returning you back to work. That's not a class that they take in medical school. They're winging it too, like they are trying to kind of play it by ear and figure out if you're capable or not capable of going back to work. And if they've done workers comp for a long time, maybe they know how the system works, and they say, Well, you know he's He's fine, he'll be okay, but maybe you're not fine, right? Maybe they're just tired of treating you as a worker, treating workers comp patients, and they just want you out of the office and to go back to work because you're just sitting out because you want to collect checks in their mind. But that's not the reality. The reality is is that you are hurt and exactly what you described, you're trying to work through the pain, but you can make the thing worse, and you could be a liability to your own employer, in that sense, if your shoulder is still giving you pain, and you're working a machine or equipment and you don't do it right, you could be a danger to yourself or to others, and we just want to make sure that when you go back to work, you are physically ready to go back to work. Thank you, Brian, when we come back, I'd like to talk to you a little bit about what we can do to counter some of these positions taken by doctors under these circumstances. So join us in the next episode. Thanks for joining us. Don't forget to subscribe and follow us to stay up to date with our weekly episodes. We'll see you next time you.
