“Two-Doctor Rule”

In Illinois Worker’s Compensations victims are entitled to two doctors and their referral chains. When we get cases in, often workers have already used one of their choices. We have had many people come in who have been referred to a doctor of the employer’s choice. When the employer does this they often misrepresent or suggest to the worker that they are required to go to these particular doctors. The selected doctor is often pro insurance company and not very friendly to injury victims.

This selection can have a huge impact on a person’s case by the time the case is over. Selecting a good doctor, from the standpoint of medical ability, and the from the standpoint of insurance bias, is very important to a person’s case.

Illinois law protects injury victims by having the two-doctor rule. Even if an employer tells a worker to see the company doctor or an occupational doctor, the worker still has a right to another group of doctors.

Employees can go to two doctors in their referral chains. In other words, if you go to a general practitioner, and the general practitioner refers you to an orthopedic surgeon, who then refers you to a neurologist, who then refers you to a pain management doctor, you are only using one referral chain. With all of these mean you are still within one referral chain.

Workers should make sure that when they go to the doctor for care that they get a referral from another doctor. If an injury victim gets a second opinion, that second opinion starts the new chain, or counts as the second doctor. It is easier to get a referral for a second opinion from a primary care doctor or some other doctor. It really does not matter which doctor makes the referral, as long as there is one on file. If one orthopedic surgeon refers the patient to another orthopedic surgeon for a second opinion, this is still within the referral chain. This keeps alive the second referral chain. There is not much reason to use the second doctor in the second referral chain in most instances. However, When the issues comes up, it is often important.

There are some other important considerations. Emergency room visits are not considered an initial doctor choice nor for the two-doctor rule. On premises doctors are typically not considered an initial choice of the “two-doctor rule”.

The Illinois Worker’s Compensation Act allows for a “Preferred Provider Program”. This means that the employer or insurance company can set up a network of preferred providers for worker’s compensation medical care. When this happens, if a worker is given notice of these doctors, they can either use these doctors or they have used up one of their two doctors in the two-doctor rule. We advise using caution with the preferred provider program because these doctors are selected by the insurance company. They are often selected because they are insurance company friendly.  In order to opt out of the preferred provider program, a worker should give written notice to the employer. Once the written notice is given the worker only has one doctor in the referral chain left, but that gives the employee the right to have reasonable and unbiased doctors provide care.