Doctors Evaluate Claims Differently

Can I Change Doctors or get a Second Opinion in my Workers Compensation Case?

Kevin Holmes March 12, 2021

If you have been hurt at work, you are generally entitled to two categories of benefits: money benefits for your disability (permanent or temporary disability) and medical benefits in the form of fully paid-for medical care.

The Workers' Compensation Insurer is supposed to provide you with medical care at no cost to you for the life of the injury. But if you've been hurt at work, you are not allowed to choose just any doctor. The system limits the doctors you can see and provides a very specific process for how those doctors are chosen.

How Doctor Selection Often Works

The fact pattern is usually the same: you got hurt at work, informed your boss of the injury, and filled out a notice of accident form. Then, you (or your boss) determined you need to get checked out to see how bad the injury is and what treatment is necessary.

Under normal circumstances, you might go to your primary care doctor, or to the urgent care clinic you are used to. Or if you've had a similar injury in the past, maybe you might go back to the same doctor who treated you for that injury. But instead, your boss tells you that the company has a doctor you are required to see instead of your own.

So all of a sudden, you are wondering "why has my boss sent me to Concentra Medical Clinic" if Presbyterian Hospital is just around the corner?

It is in part because not every doctor accepts Workers' Compensation Insurance payments, and also because Workers' Compensation carriers contract with certain providers for Workers' care.

So you go to the Concentra clinic and see a really nice doctor who sends you to physical therapy and, maybe, gives you a corticosteroid injection. But you don't get better. After six weeks of therapy, you feel like something is still wrong. But the doctor can't (or won't) send you for an MRI to see why that pain just won't go away.

So you wonder "can't I just go to my own doctor instead?" Or you wonder "can't I get a second opinion?"

The answer: Maybe.

New Mexico law has a very specific process for choosing doctors in a Workers' Compensation case.

In New Mexico, the presumption is that an employer will choose the doctor for the injured worker. This presumption harkens back to the olden days when mining camps and labor companies had "company doctors."

However, the employer has the right to allow a worker to choose his or her doctor instead.

But there's a catch!

Generally, the party who did not choose the worker's doctor gets to change care (if the party wants) after the worker has treated with the doctor for a period of time. This is called a "second selection."

There is a specific process that a person has to follow in order to make a second selection, and whether the Worker has that right will depend on a few things.

The Choice of your Doctor is one of the most Important Choices in Workers' Compensation Claims

Under New Mexico law, only doctors who have been specifically selected through the proper process are allowed to testify at trial. That means that if you see your own doctor independently and that doctor diagnoses you with an injury, you can't use that doctor's records or testimony to prove your claim! So even if your own doctor says you need an MRI, his or her opinion isn't going to budge the Workers' Compensation Adjuster or the Judge.

Because of this limitation on evidence in cases, it's imperative that a worker is seen by a good doctor who knows the Workers' Comp system and knows how to ensure a Workers' care is sound both medically and legally.

If you've been hurt at work, contact Holmes Law Firm and speak to a New Mexico Workers' Compensation who knows the best doctors and knows how to ensure your rights are protected in this complicated system. We can represent you no matter where in the state you live and will review your case with no cost up front.