Episode 68: In this episode, Calloway County workers’ compensation attorney Jeff Roberts discusses 2 important forms you’ll need to complete when filing a workers’ comp claim in Kentucky. The first is the Designated Physician Form and the second is the Expense Reimbursement Form.
The Notice of Designated Physician Form
This is also referred to as workers’ compensation Form 113. This form is sent to you by the workers’ comp insurance company. You’ll use this form to specify a certain doctor to as your medical gatekeeper. This physician will oversee your care and may refer you to a specialist, if needed. However, your designated physician will play a key role in managing your medical treatment. Think of him or her as your quarterback. While others may be involved, your designated physician will coordinate the treatment plan.
Be aware that your employer may try to have you treat with a specific doctor or medical clinic. This is not always in your best interest. It’s a way for them to control the cost of your treatment. You typically do not want to specific that doctor as your designated physician. Jeff explains why, next.
Under Kentucky law, you can voluntarily make your initial designation, with the option of changing it one time. After that change, you would then be required to have the insurance company (that’s being paid by your employer) approve any additional changes.
Here’s how the game often plays out. You get injured on the job. Your company refers you to a doctor who has a relationship with your company. You may complete Form 113 designating that doctor has the physician in charge of your treatment. Then, that doctor might decide to refer you to a specialist, who may also have a relationship with your company. The worker might be encouraged to designate the specialist. Basically, at that point, you’ve now used up both authorizations and now the insurance company is in control, not you.
The insurance company would not be required to approve another change, regardless of how you feel you are being treated or how you get along with that doctor. It’s a game that gets played often without the injured worker realizing that they’re even on the field.
Maintaining Control of Your Treatment
Kentucky law provides a significant benefit to injured workers. You have the right to choose your own doctor. You have the right to decide where you want to receive treatment. You have the right to select your own pharmacy. Even though these decisions are your right, the insurance company will try to make you fight for them, if you even know you have those rights in the first place. This is an important reason why you should hire an experienced workers’ compensation attorney to represent you.
Jeff points out a significant factor in the mind of most judges dealing with workers’ compensation claims. The judge tends to put more value in the comments/orders of the doctor who’s treating you, rather than another doctor who is simply offering an opinion about what type of care you should be receiving. For this reason, it’s important that you maintain control of the physician managing your treatment. One way to do this is by making sure you designate the doctor you want, by properly completing the Form 113.
If your employer has a managed care network, you may be required to use someone in that network. However, you have the right to pick the doctor within that managed care network. Again, the insurance company cannot tell you specifically which doctor you have to see.
Should You Designate Your Family Doctor?
Jeff mentions that there are a few doctors who prefer not to get involved with workers’ compensation cases, because the of the extra paperwork and other considerations. However, as a rule of thumb, using Form 113 to designate your family doctor as your designated physician is a good idea.
Your family doctor would then have the ability to refer you to trusted specialists, as needed. There’s always the chance that you might not get along with a particular specialist. Your family doctor could refer you to a different specialist. If you designate the specialist as your designated physician, and they decide to select a different specialist, he/she might not be as willing to make that referral to a competitor. Again, having your family doctor as your quarterback can be a significant advantage in your care plan.
Shifting the Blame
Jeff discusses how the insurance company may encourage a doctor to blame all or part of your pain on a pre-existing condition. Once you’ve been injured, the insurance company will do a careful review of your health record. If they can determine you previously complained of similar pain in the same area of your body, they may be able to get out of paying for the treatment. In Episode 30, Jeff discussed dealing with pre-existing conditions.
Are You Being Denied Specific Tests or Medications?
This can be a red flag. Jeff has over 30 years of experience representing injured workers. There are situations in which he is generally familiar with the type of treatment, testing and medications you should be able to get. Obviously, he defers to the doctor, but if it looks unusual, he can step in to see if there’s a reason you aren’t getting the proper treatment or if something is getting denied that probably shouldn’t be. You want someone on your side who knows the system and what types of games get played.
You Can Get Reimbursed for Expenses
Money is tight for many families. When the insurance company tries to require you to use a specialist who may not have a local office, such as in Nashville, you may be concerned about the cost. Luckily, you can usually get reimbursed for your expenses related to your medical treatment. You’ll need to use Form 114.
The Request for Payment or Reimbursement for Compensable Expenses (Form 114) is a fairly easy form to complete. The insurance company may not tell you that you have the right to be reimbursed for certain expenses, including mileage. This is because they are responsible for paying you for these expenses.
If you seek medical treatment directly after you get hurt, there’s a good chance your claim has not been submitted within the workers’ compensation system. You may have to initially pay for a prescription or for a co-pay. Once the claim is setup, you’ll the workers’ comp insurance carrier will receive these invoices.
However, in the meantime, if you incurred expenses, you can use Form 114 to submit them for reimbursement.
The 60-Day Requirement for Expenses
It’s important to understand you have to submit your expenses within 60 days. If you travel to see a doctor or specialist, don’t wait to submit the expenses. Go ahead and get it done so you don’t risk having the expense denied. Remember, mileage expense can quickly add up.
Form 114 is submitted to the insurance carrier, not to your attorney. It’s a good idea to keep a copy of the expense form, for your records. Make sure you note when it was submitted. If the form gets lost, you’ll have proof of having submitted it.
In Episode 64, Jeff spoke about the other expenses that might qualify for reimbursement. These might include hotel stays and meals, depending upon the circumstances. There is a “reasonableness standard” that applies. If you are traveling out of town for a surgery or other early morning procedure, it might be reasonable for you to get reimbursed for the related expenses. Some hospitals may have special rates for out-of-town patients. Some insurance companies will also approve expenses for your spouse who needed to travel with you.
What Do Other Clients Think About Jeff?
We always encourage listeners to read the Google Reviews Jeff Roberts has received from many of his clients. A 5-Star rating and the comments are earned recognition and demonstrate Jeff’s commitment to his clients. As a solo attorney, he has more Google Reviews than some firms with multiple attorneys. Jeff shares the credit with his staff at the Roberts Law Office. Successfully representing a someone who was hurt on the job is a team effort. It’s why Jeff likes to say his firm offers small town service with big city results.
Jeff Roberts Represents Injured Clients Throughout Kentucky
With offices located in Calloway County and now Christian County, Jeff has a history of representing personal injury clients, workers’ compensation clients and social security disability clients across the state. He’s represented clients from Paducah, Bowling Green, Louisville, Covington, Whitesville and many other Kentucky locations. He’s not just a Western Kentucky injury attorney.
We hope you found this episode insightful and helpful. Thank you for listening!
Is It Time to Speak with an Attorney about your Workers’ Compensation Claim?
The office phone number is (270) 753-0053 or toll free at 800-844-5108. For more information, visit www.JeffRobertsLaw.com. This podcast is meant to provide information and is not legal advice. Jeff’s principal office is located at 509 Main Street, Murray, Kentucky. Co-host Jim Ray is a non-attorney spokesperson. This is an advertisement.
