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If I suggest a referral doctor’s name to my current doctor does that break the chain of referral?

Posted: January 23rd, 2012 | Author: | Filed under: Injured Workers, Medical Treatment, Workers Compensation Claim | Tags: , , , , ,

          Under the Illinois Worker’s Compensation Act, if there is no “Preferred Provider Program” in place with your employer, then you are entitled to two choices of doctor. What this really means is that you are entitled to have two “chains” of doctors.  As long as there is a referral from doctor to the next you stay within that chain. If you go outside these two choices then the Employer is no longer liable for your medical care even if it is related to the work injury.  So what happens in the instance when you know what doctor you want to see on referral and you suggest that name to your current treating doctor for his or her referral?  Does that mean it is not a referral anymore but another choice under the Act?

            The simple answer to that question is no.  As long as there is a referral to see the other doctor, then it will not count as another choice.   A recent case that was affirmed by the Appellate Court of Illinois expressed this idea that the law does not reference where the name of the referral doctor came from, the law simply requires that the treating doctor make the referral to that doctor.

            This is useful in the event that you are treating with your primary care doctor and she indicates that you need to see a specialist, let us say an orthopedist.  Let us also say that in the past you had seen an orthopedist for a complete unrelated condition, but you really liked and trusted this doctor.  The Worker’s Compensation Act allows you to suggest this doctor as your specialist to your primary care doctor and as long as she makes a referral to him or her you will not have exhausted a choice under the Act.