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Can I Choose My Health Care Provider with Workers’ Compensation?

Joanow Legal Group Jan. 17, 2019

Pennsylvanians who suffer a workplace injury or become ill because of their work will need medical treatment. Some will want to see a medical professional of their choosing. Others are concerned that their workplace will have certain doctors and hospitals that it requires workers to use for their treatment if the worker is to receive workers’ compensation benefits. Understanding what workers’ compensation law says about choosing a health care provider is critical.

Workers have the right to select a health care professional of their own choosing except when the employer accepts the workers’ compensation claim and there is a posting in the workplace that lists six or more health care providers or physicians for the workers to choose from. The worker must visit one of those listed when they are getting their initial treatment. The treatment must continue with that provider or another one on the list for 90 days after the initial visit. The employer is not allowed to steer the worker to a specific medical provider.

When the provider says that the worker needs to have invasive surgery, the worker can get a second opinion that will be paid for by the insurer or the employer. The treatment the second opinion recommends must be provided for 90 days. In that 90-day period, if the worker goes to a medical provider who is not on the list, the employer or the insurer can refuse payment.

After 90 days have passed or when there is no posting listing of providers or the list is improper, the worker can get treatment with any medical professional he or she wants. The employer must be informed. While treatment is taking place, the employer or the insurer can get reports from the medical professional monthly. Once the workers’ compensation benefits have started, the employer or insurer can ask the worker to see their choice of medical professional for an examination. A refusal could spark a judge to require the worker to go to the examination. Failing to adhere to the order might stop the benefits.

Being injured or suffering an illness on the job can be a worrisome time for workers. Workers’ compensation benefits are meant to allay those fears and let the worker get back to health while getting medical care and payment for lost wages. However, a dispute over that medical care can happen, leaving the worker unsure of how to respond. When this happens, it can help to have advice from professionals experienced in this area of law.