Even in states where the employer has the sole right to choose medical care
providers under workers’ compensation, there is an exception for emergency
care. If a patient presents to an emergency room or a doctor’s office with an
injury or illness that may threaten life or limb, that person should be treated
appropriately. Most hospitals and emergency room personnel are well aware of
the penalties under federal law for turning away such a case. However, this is
not an excuse for ignoring the state’s laws on choosing workers’ compensation
It is common practice for the hospital to contact the insurance company to get
permission to treat a patient, so that the insurance will cover the bill. In real
emergencies this is done after the treatment is started. For the patients with an
earache or a cough, it is usually done first. Particularly in managed care plans,
the insurer may direct the patient to another hospital or to an office the next
day. If there is no medical reason why the patient cannot wait, this is legal and
acceptable practice. The patient may choose to pay cash and receive
treatment there or they may go where their insurance will pay the bill.
Work-related injuries should be treated the same way in an emergency room.
Federal law requires medical triage. If the illness or injury is a true emergency,
treatment should be rendered immediately and the employer contacted later. If
the hospital has a formal or informal agreement with the specific employer to
provide workers’ compensation care, then this should be adequate. If the
patient does not have a life- or limb-threatening emergency and the hospital
does not have an agreement with the employer, then the employer should be
contacted before care is given, subject to the requirements of EMTALA. In any
state, the patient may choose to pay cash for the visit and argue it out with
the workers’ compensation insurance system later. And, in some states, it is
unwise to ignore the requirement to notify the employer unless you are
thoroughly familiar with the state and federal laws.
In a doctor’s office when providing routine care, there is no justification for
ignoring the employer. If the employee is claiming a work-related injury and he
or she wants workers’ compensation to pay for it, the employer has a legal
right to the employee’s relevant medical information. The doctor should be
prepared to work with both the patient and the employer or should not be
practicing occupational medicine.