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Choosing a doctor who takes workers' comp

What is an attending physician?

Under Oregon workers' comp laws, different kinds of medical providers can provide different levels of treatment. Your treatment must always be from a qualified attending physician; if you are currently being treated by someone not listed below, contact your adjuster right away. 
View the attending physician chart

Type A providers

The providers below always qualify as attending physicians (AP). (They're also known as Type A providers.) They can treat you for as long as it takes to get you medically stationary.

  • Medical doctors
  • Osteopathic physicians
  • Podiatric physicians and surgeons
  • Oral and maxillofacial surgeons

Other providers 

These providers may qualify as an attending physician, but treatment is limited. (They're also known as Type B providers.)

  • Nurse practitioners may treat you and authorize time loss for 180 days.
  • Physician assistants, chiropractors, and naturopaths who are certified by the Oregon Workers' Compensation Division may treat for a total of 60 days or 18 visits on the initial claim, and authorize time loss for up to 30 days.
  • Emergency room physicians are limited to authorizing 14 days of time loss (unless they also treat you on an ongoing basis in a clinic setting).
  • If you are enrolled in a managed care organization (MCO), the MCO may have different limitations on attending physicians.

The Attending physician chart summarizes what different providers can do under workers' comp rules.

It's a good idea to start with a doctor you're comfortable with who also qualifies as an attending physician (AP), so you don't have to change doctors later. Be aware that if you sign an 827 form at a doctor's office, you are authorizing that doctor to be your AP (if that box is checked).

If you aren't sure who your AP is, log in to MyClaim and review your file. If that information is not accurate, contact your adjuster.

Responsibilities 

The primary responsibilities of an attending physician are:

  • Providing your treatment and care
  • Providing specific work restrictions
  • Monitoring, directing, or writing referrals for specialized care by other providers

If you aren't sure if your provider qualifies or if the information in your file in MyClaim is not correct, contact your adjuster.

Changing your attending physician

Once you select an initial attending physician, you may change two additional times before your claim closes. Contact your adjuster if you think you need an additional change.

How to change your attending physician:

  • Sign the 827 form and check the "Notice of change of attending physician or nurse practitioner" box.
  • Be treated by a new physician; be sure to tell your adjuster.

Managed care organizations (MCOs)

To help with your treatment, SAIF works with MCOs (networks of medical providers who have experience with workers' comp and agree to follow workers' comp system rules). MCOs develop treatment standards that emphasize quality medical care and disability management. 

What are the benefits of MCOs? They:

  • Have knowledge of the workers' comp process
  • Have a comprehensive network of specialists
  • Are an independent resource for your attending physician and SAIF that can help manage your treatment plan
  • Work with other MCO providers to ensure appropriate medical treatment
  • Will help keep your medical care moving forward
  • Can review and precertify medical treatment to make sure it's appropriate and necessary

If your claim is enrolled in an MCO and your doctor is not on that MCO's panel, then you will probably be required to seek treatment from a qualified MCO provider.Your MCO enrollment options are:

  • Stay with your attending physician if that physician is on the MCO panel
  • Change attending physicians to one of the MCO panel members
  • Ask your primary care physician to become part of the MCO panel

If you move to a new city during your recovery, please tell us so that your adjuster can advise you how to continue your medical care uninterrupted. Gaps in your medical care could have an effect on your compensation and benefits.

For the most up-to-date provider lists, visit the MCO websites at:

Printable MCO directories:

Note: You must have Kaiser for your personal health care insurance in order to enroll in Kaiser for your workers' comp claim treatment.

Log in to MyClaim to see what MCO you are enrolled in.

From saif.com

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