When can I choose my own doctor to treat a work injury?
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A prime benefit of the workers’ compensation system is the coverage you can get for your medical treatment costs following a work injury. However, you might not get compensation if you visit any doctor you choose. It depends on the situation.
An employer may establish a designated-provider list. The 90-day treatment requirement applies only when the employer meets the legal list, notice and acknowledgment requirements; it does not bind you to one particular listed doctor.
An improper physician list
In the absence of a posted list, state law allows you to pick your own care provider. Still, even if your employer has posted a list, you should read it carefully. State law establishes various requirements for a physician list, including but not limited to the following:
- Specialty and contact information for each provider
- At least three providers are physicians
- The providers are geographically close
- Providers can treat work-related conditions
If your employer fails to provide a list that follows Pennsylvania law and regulations, you may seek a care provider of your choice to give you treatment.
A need for a specialist
A designated provider may refer you to a specialist who is not on the list. Other exceptions can also permit non-panel care; confirm the applicable route before assuming the insurer must pay.
The state workers’ compensation system is flexible enough to offer various options to help you get treatment. Keep in mind that your employer cannot require you to go to a specific doctor. Your choice of provider is governed by these treatment rules and their exceptions.