Can I Choose My Own Doctor for Workers' Comp in Illinois?

The two-physician rule

The Act requires the employer to pay for necessary medical care for a work injury, limited to treatment by two physicians the employee chooses and the providers in each physician's chain of referrals. A referral from a chosen physician does not use up a choice. Emergency care does not count as a choice either.

Preferred Provider Programs

An employer may set up a Preferred Provider Program, a network approved by the Illinois Department of Insurance. The employer must tell employees about it in writing. An employee may decline the program in writing, and declining counts as one of the two choices.

Treating outside the program does not count as a choice in two situations: when no provider in the program can deliver the treatment needed and the pre-authorization requirements were followed, or when the Illinois Workers' Compensation Commission finds the program's treatment inadequate.

What happens outside the two choices

An employer may not be required to pay for care from providers beyond the two choices and their referrals. A written referral from a current physician is the usual way to add a specialist without using a choice.

How INC fits in

INC does not treat patients. A coordinator takes the call, learns what happened and schedules the worker with a licensed provider for chiropractic care, physical therapy, pain management or imaging. The providers make every clinical decision.