What is the 2-doctor rule in Illinois?

Nurse and doctor examining xrayRecent reforms to the Illinois Workers’ Compensation Act may have significant effects on injured employees. HB 1698, a bill passed in June 2011, places a number of restrictions on disability payments, medical fee schedules and arbitration processes. HB 1698 also changes the rules regarding doctor choice for injured workers. The so-called two-doctor rule is one of the most important reforms.

An introduction to the 2-doctor rule

According to the new guidelines set out by the reformed Illinois Act, employers are now entitled to set up a limited network of medical providers for employees who suffer injuries on the job. This network is known as a Preferred Provider Program. As every Chicago workers’ compensation lawyer is aware, Illinois law now allows each worker to choose a maximum of two doctors within the employer’s PPP.

Opting out of the employer’s PPP creates a “1-doctor rule”

Workers may decide to opt out of the employer’s PPP and see a single doctor of their own choosing. Some people who have a good pre-existing relationship with an outside care provider may choose this path. Workers who opt out must notify their employers in writing. Revised Illinois law counts the act of opting out as a doctor choice, leaving the employee without the right to further benefits for a job-related injury if he or she sees a second doctor outside the PPP. Injured workers must be aware of this limitation before they make the difficult decision to opt out and gain greater freedom of doctor choice.

Exceptions for doctor referrals

The two-doctor rule in Illinois does not apply to referrals. If one of the two PPP doctors refers an injured worker to a specialist or another medical professional, that specialist’s care is covered by workers’ compensation. If that specialist refers the worker to a further specialist, the second referral is also covered. This chain may continue indefinitely as long as the worker needs specialized medical care.

Emergency exceptions to the rule

The two-doctor rule is designed to regulate long-term medical care after an accident. A Chicago workers’ compensation lawyer knows that it does not apply in emergency situations such as the following:

  • First aid at the site of an accident on the job
  • Emergency room treatment immediately after an injury or sudden illness
  • Medical treatment received before the worker is able to notify the employer

Workers in acute emergencies can seek treatment from any doctor inside or outside the employer’s PPP.

Seeking help after an injury

According to the U.S. Occupational Safety and Health Administration, 3.4 out of every 100 American employees are seriously injured on the job every year. Illinois labor law can be complicated. Disabled workers should contact a Chicago workers’ compensation lawyer about the details of their case.

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