When you make a workers’ compensation claim, you need to provide proof of your workplace injury or illness. The severity of your illness or injury will also determine the benefits that you are entitled to receive. Your doctor will review your medical condition, assign you an impairment rating, and determine when or if you can return back to work. Your doctor will also specify any limitations on the kinds of work you will need to do.

In some cases, employers, insurance companies or even the Division of Workers’ Compensation will not be 100 percent confident that they are getting correct and comprehensive information on your health status. You may be asked asked to submit to a medical exam when making a work injury claim in order for the insurer, employer or Division of Workers’ Comp to get the information they want and need.  You may be required to undergo this exam, but you should always talk to a Texas work injury lawyer before you do.

What to Do If You Are asked to Submit to a Medical Exam When Making a Work Injury Claim?

When you are  asked to submit to a medical exam when making a work injury claim, it is natural to be worried about whether the doctor will look out for your interests or not. After all, a doctor hired by an employer or an insurer may have loyalty to the company that hired him and may be focused on saving the company money rather than on your health.

Unfortunately, you generally cannot simply refuse to undergo a medical exam. You have to be cooperative, within some limitations. Section 408.004 of the Texas Labor Code provides details on an injured worker’s rights and obligations when asked to submit to a medical exam when making a work injury claim. Under this law:

  • The commissioner of the Division of Workers’ Compensation can require an injured worker to undergo a medical exam in order to resolve questions about whether the worker has received appropriate health care.
  • The commissioner may require an injured worker to undergo a medical exam at the request of the insurance carrier. However, the insurer should try to get permission from the employee before going to the commissioner. The insurer is entitled to an exam just once over a period of 180 days, although the commissioner can adopt rules requiring an employee to undergo up to three exams during this time period in certain cases.  For example, an additional exam could be required to determine if the worker’s condition has changed.

The insurance carrier has to pay for an exam requested by the company or the commissioner. An injured employee is also entitled to have a doctor of his or her choice present at the required exam. The insurer is responsible for paying a set fee for the employee’s doctor to be there.

If you are asked to submit to a medical exam when making a work injury claim, it is a good idea to contact an attorney for help determining if you must undergo the exam. Abbott and Associates, L.L.C. has helped many clients throughout the workers’ compensation claims process and we can advise you on your rights. Call today to learn more.

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