How injured workers can pick a doctor shortly after an injury
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If you get hurt on the job in Pennsylvania, workers’ compensation covers your reasonable and necessary medical treatment. Whether you can pick your own doctor during the first few months depends on your employer. If your employer has posted a valid list of at least six designated health care providers, including at least three physicians, and gave you written notice of your rights, you generally must treat with a provider on that list for 90 days from your first visit to one of them. You choose which listed provider to see, and you can switch among them. If there is no valid list or no proper notice, you can see a doctor of your choice from the start.
Even when a valid list applies, certain exceptions broaden your choice of doctors. Knowing about these options could protect your health if you need a sensitive medical procedure or quick care.
Emergency situations
Under the Department of Labor and Industry’s regulations, a worker does not have to select a listed provider in the event of an emergency. Your immediate health is your top priority. The law will not penalize you if you need quick attention from a provider who is not on the list. Once the emergency is over, follow-up care generally must come from a listed provider for the rest of the 90-day period.
A second opinion
A listed physician may recommend that you undergo invasive surgery. You will likely have concerns about undergoing an operation, particularly one that poses some risk. Fortunately, you can get a second opinion from any provider of your choice, and your employer pays for it. If the second opinion differs and gives a specific, detailed course of treatment, you can decide which treatment to follow, although that treatment generally must be performed by a listed provider for 90 days from the second-opinion visit.
Research published in BMJ Open found that while many second opinions supported the first diagnosis or treatment, a second opinion still offered clarification in 17% of cases and an outright change from the first diagnosis in 13-15%. So a second opinion has the potential to offer you information you need to make proper care decisions.
A referred provider
After an examination, a listed physician could conclude that a different provider is the right choice to treat you. Even if that provider is not on the list, treatment by a provider you were referred to by a listed provider is paid for by your employer, and you can move on to the next step in your care.
A required provider
The nature of your injury might require a specialist who is not on the employer’s list. If so, ask a listed provider for a referral. Care from the specialist you are referred to is covered, just like care from the listed provider.
After the 90 days
Once the 90-day period ends, you may treat with any provider you choose, and your employer must pay for reasonable and necessary treatment. You must notify your employer within 5 days of your first visit to a provider who is not on the list; otherwise, your employer may not have to pay for treatment before it receives that notice. If you see an off-list provider during the 90 days without an emergency or a referral, you may have to pay for those visits yourself.
According to state law, your employer must make you aware of these choices in writing. Knowledge of the law and your situation can go a long way to securing your rights. Learn more about workers’ comp medical benefits. To learn more about how you can receive help after a work injury, contact YOUR Workers’ Compensation Specialist for a free, no-obligation consultation. Call 610-892-9300, text 610-255-7183 or reach us online.