What Do You Think?
Does two plus two ever equal two? In Illinois, it may. Illinois employers and workers compensation carriers need to know about the “the two physicians” rule. A recent case involving a driver for Coca-Cola explains how the rule works in practice to limit the number of doctors a claimant may select.
The driver in that case hurt himself while pulling a dolly at work. He was ultimately diagnosed with a torn bicep tendon.
He saw several healthcare providers for the injury. First, he chose to see Dr. Young, at Orthopedic Institute. Dr Young referred him to Dr. Davis, another surgeon at Orthopedic Institute.
Next, he saw Dr. Rotman of Orthopedic Center of St. Louis at his employer’s request, for an independent medical examination.
The claimant later followed up with Dr. Rotman. Dr. Rotman noted that claimant was there “through his private health insurance.” Dr. Rotman recommended that claimant seek treatment with Dr. Crane of Orthopedic Center of St. Louis.
When the claimant’s attorney asked the claimant at the hearing if Drs. Rotman and Crane were his “choice,” claimant responded, “No, sir.”
After seeing Dr. Crane, claimant presented for a second IME with Dr. Daniel Kitchens at the employer’s request.
The claimant then sought treatment with Dr. Bradley of Metro-East Orthopedics. Dr. Bradley referred claimant to Dr. Gornet of Orthopedic Center of St. Louis. Claimant saw Dr. Gornet.
The employer contended that the claimant exceeded his choice of doctors under section 8(a) of the Act.
Under that section, known as the two physician rule, an employer’s liability to pay for medical services to: 1) first aid and emergency treatment plus; 2) two additional doctors chosen by the employee; and 3) any additional providers and services recommended by the two physicians selected by the employee
The workers’ compensation commission ruled for the claimant. The employer appealed.
Did the claimant exceed the number of providers allowed under the 2-physician rule?
A. Yes. Even if he didn’t choose to see Dr. Rotman, he selected four other physicians.
B. No. The role counts doctors, that the claimant selects, but not the providers those doctors refer the claimant to.
If you selected B, you agreed with the court in Heartland Coca-Cola Bottling Company v. The Illinois Workers’ Compensation Commission, No. 5-25-0964WC (Ill. Ct. App. 08/13/26), which affirmed the lower court’s ruling.
The appeals court agreed with the Commission that Dr. Young was the claimant’s first choice. Dr. Young’s referral of claimant to Dr. Davis in the same practice continued claimant’s first choice of physician for purposes of the two physician rule.
The next physician he saw, Dr. Rotman, was chosen by his employer, and “thus, Dr. Rotman did not constitute claimant’s second choice of physician for purposes of section 8(a) of the Act,” the court said. Neither party was disputing that the employer sent the claimant to Dr. Rotman for an IME.
The court acknowledged that it was unclear whether the claimant actively chose to continue treating with Dr. Rotman or whether he felt obligated to follow Dr. Rotman’s recommendations that he see Dr. Crane. Significantly, however, claimant testified that neither Dr. Rotman nor Dr. Crane were his “choice.”
Thus, there was some evidence supporting the Commission’s finding that Dr. Rotman was not “chosen by” claimant
The Commission’s finding that claimant’s second choice of physician was Dr. Bradley, who referred claimant to Dr. Gornet, was not against the manifest weight of the evidence. Thus, the claimant did not exceed the two-physician rule.
