Choosing Your Own Doctor vs. Company Doctor: What Illinois Law Allows in Workers’ Compensation Claims

When you’re hurt at work, you aren’t swinging by the HR office to confirm your workers’ compensation rights. No. You are calling 911 for emergency treatment or someone’s driving you to a local clinic. Looking back, you probably wish you’d paid more attention to those workers’ compensation sheets your employer gave you when you were hired. Now you’re wondering whether it’s better to choose your own doctor vs. the company doctor.

You don’t have to blindly accept what’s always been done. Don’t give up your right to choose your own medical care team for your work injury.

Key Takeaways

• Illinois workers' compensation lets employees choose two doctors for treatment.
• The referral chains following the initial choice do not count as a separate doctor choice.
• Emergency treatment is exempt from the two-choice limit.
• A Section 12 exam (also called an Independent Medical Examination is separate from the two-doctor choice.

The Two-Doctor Rule: What Illinois Law Actually Guarantees

What does Illinois law actually say about choosing your own doctor vs. the company doctor?

You don’t have to accept the medical care team that your employer chose for you. You shouldn’t feel forced or obligated to be treated by healthcare professionals that you didn’t have a say in choosing. Under 820 ILCS 305/8(a), as the injured employee, you can choose to find and use your own physician, surgeon, and hospital services at your employer’s expense. The law is slightly more complex than this, though. Employers have several workers’ compensation obligations in Illinois.

Employees can choose two treating providers, including the referral chains associated with those choices. The employer is generally responsible for covering eligible treatment within those choices. First, employers must pay for emergency first aid treatment. Then, the employee can choose up to two medical professionals for treatment. Illinois law is clear about how referral chains work, which is a key component to an employee’s treatment choice rights.

Suppose an employee chooses their general practitioner for initial treatment. The doctor refers the employee to a specialist, who then orders testing. Based on the results, the treating providers may refer the employee to a surgeon or recommend physical therapy. These providers fall within the same referral chain. All of these referrals are links in a chain coming from the initial doctor choice. As long as the employee obtains the proper referrals, they only count as one choice.

The second choice comes into play when the employee chooses a different treating provider outside the first provider’s referral chain. That second provider and the providers they refer the employee to make up the second choice.

The Emergency Treatment Exception (and How It's Easy to Misunderstand)

When there’s a real emergency, you don’t want to waste time thinking about choosing your own doctor vs. the company doctor or arguing about where to get treatment. Thankfully, Illinois law recognizes this. So when an incident happens at work that results in a true emergency requiring immediate first aid, that treatment won’t count towards the employee’s two choices. Under Illinois law, this is a separate situation that the employer must cover.

The One Real Exception: A Preferred Provider Program

The Preferred Provider Program (PPP) is an exception to Illinois’ employee choice rule. Under 820 ILCS 305/8.1a, employers can create their own IWCC-approved Preferred Provider Program. This program is specifically designed for the employer’s workers’ compensation program.

For employees, an employer’s PPP program is different from a company-offered PPO health insurance program. One is specifically meant for workers’ compensation claims. The other is standardized health insurance.

If your employer has a PPP, they must tell you about it in writing. Employees can choose to decline the program in writing. While they can choose to decline at any time, doing so counts as one of the employee’s two choices. Choosing a non-PPP provider for non-emergency treatment before ever reporting the injury also counts as one choice.

There's No Legal Requirement to See “The Company Doctor”

There’s no statute in Illinois that requires injured workers to see the doctor their employer chose. For employees, it can feel like this isn’t the case. When it comes to choosing your own doctor vs. the company doctor, some employers may act as if there is a requirement to see the company’s doctor. This may lead their employees to believe that they must follow what their employer says. There’s an assumption that the employer must know and follow the law, so what they say goes.

Some employers may already have a relationship with a particular clinic or have just have a routine of going to a particular clinic. This establishes a pattern of behavior that can lead employees to believe that they too are required to go to the established clinic. However, going to the employer’s clinic may simply be convenient for the employer.

Sometimes, employees are confused about their rights. An employer can require an employee to attend a Section 12 examination, also called an Independent Medical Examination (IME). However, the examination is not intended to provide treatment. Its purpose is to evaluate the nature and extent of the employee’s injuries. However, this exam isn’t for the purposes of treatment. Instead, it’s to evaluate the nature and extent of your injuries. A Section 12 exam is a separate workers’ compensation function from seeking treatment. It doesn’t replace or remove the employee’s right to two choices for treatment.

Why This Distinction Actually Matters

It may seem like a formality or minor detail, but using both of your two choices can complicate your ongoing and future treatment. A future doctor change may require the employer’s approval. The employee may also face having to pay for this additional doctor out of pocket. If you are unsure of how many doctor choices you have used, speaking with a workers’ compensation attorney can be helpful. They can evaluate your situation and determine whether you have exercised your two choices. If you have, they can give guidance on how to move forward to ensure you receive qualified medical care.

Contact a Chicago Workers' Compensation Attorney

When you get hurt while on the job, your focus should be on healing, not thinking about choosing your own doctor vs. the company doctor. You shouldn’t have to figure out your medical and workers’ compensation rights while you sit in the break room with an injury.

Understanding your rights early on helps you advocate for yourself. Stephen Hoffman can help you with his experience in representing clients with workers’ compensation claims. Use (773) 944-9737 and stephen@hofflawyer.com to schedule a free consultation today and talk with a lawyer who understands your situation.