Two Doctor Rule

If you’ve been injured while working, Illinois law entitles you to receive medical care at your employer’s expense. This right is not without limitations, however. The law does not permit you to keep choosing a new doctor until you find one that tells you what you want to hear. Rather, it only entitles you to the choice of two doctors, as well as any other doctor those two doctors refer you to. This is commonly referred to as the “Two Doctor Rule” and is contained in Section 8(a) of the Workers’ Compensation Act.

Emergency room physicians are never considered one of your choices. Neither are any doctors who practice at your worksite, such as a company doctor at a large factory. However, a clinic your employer pressures you to visit may often be considered a choice of doctor, depending on how much control you had in seeing that doctor.

For example, you work in a meat packaging factory and fall when you step on a piece of meat. When you can’t get back up, your employer calls you an ambulance to take you to the emergency room. The next day, your supervisor tells you that you are expected to follow up with the clinic that treats people who get hurt at your work, so you follow his instructions. After four visits over the course of a month, you notice no improvement and suspect that the company clinic’s goal is to keep costs down rather than ensure you receive the best medical care, so you call your family doctor. You have now used both of your two doctor selections: the company clinic and your family doctor. You cannot now go see a chiropractor or an orthopaedic surgeon on your own and expect your employer to pay for it. In this circumstance, you must get a referral from your family doctor to see any other physician.

Perhaps your primary care doctor refers you to physical therapy, then for an MRI, and then to a spinal surgeon, but you decline surgery so you are then referred to a pain management physician. All of these doctors are part of the same chain of referrals and thus all necessary treatment they provide you will be paid for by your employer. Make sure that the doctor you see has your best interests at heart and has experience with treating your particular injury. Some doctors may have ongoing relationships with your employer. Choosing the wrong doctor may delay your recovery or harm your legal case. Also, make sure you don’t choose more that two doctors or you may be stuck paying your medical bills yourself.