Workers' Compensation Questions Answered: May I Choose My Physician?
September 16, 2011
May I choose my physician?
Unless your employer has posted a list of medical providers with whom you must treat in connection with a work injury, you have the right to choose your own physician. If, however, your employer has posted a list of at least six (6) designated health care providers, no fewer than three (3) of whom are physicians, you must treat with one or more of these medical providers for a period of ninety (90) days from the date of the first visit to the provider. If the list is not posted, and you are not told of your rights, you are under no obligation to treat with any medical provider recommended by your employer.
If the employer has posted a list of medical providers, you have a right to choose any of the providers on the list. The Act does not give your employer the right to force you to treat with a specific provider on the list.
If you do not comply with this particular provision, the employer and its workers’ compensation insurance company are not required to pay for health care services provided during this period. Your refusal to treat with an employer’s panel physician does not relieve the employer of its obligation to pay wage loss benefits to you during your period of disability. You may, however, have to pay for your work related medical treatment, because your health insurance company may not be responsible for medical bills incurred during this period of time.
In the event that a dispute arises concerning the insurance company’s obligation to pay for medical bills incurred during this period of time, your employer or its worker’s compensation insurance carrier must produce a document signed by you in which you acknowledge that you understood your rights and duties under this section of the Act.
Must I treat with an employer-designated physician if my claim has been denied?
The Act is silent about whether you have an obligation to treat with an employer-
designated physician in the event your claim is denied. If you treat with an employer-designated physician after your claim has been denied, however, you could end up being responsible for large medical bills, particularly if you have health insurance through a health maintenance organization (HMO).
Insurance Department regulations impose upon your health insurer the obligation to pay medical bills for your work injury in the event of a denial. Accordingly, if your employer denies your claim, you are free to seek medical treatment by the physician of your choice. You should provide your physician with a copy of the insurance company denial letter. Your physician will then photocopy the denial letter and submit your medical bills and a copy of the denial to your health insurance company.
It is particularly important that you cease treating with an employer-designated physician if your claim has been denied and you have coverage through a health maintenance organization. HMO’s ordinarily require that you treat with a primary physician. Referrals to specialists must be made by the primary physician, and the referrals ordinarily must be made to a participating specialist.
If your claim is denied and you continue to treat with an employer-designated physician, and you lose your workers’ compensation case, you may be held personally responsible for medical bills incurred in the event the workers’ compensation insurance company refuses to pay the bills of the employer-designated physician. Of course, if you have ordinary health insurance, your bills should be covered.
You should not assume that the workers’ compensation insurance company will pay your medical bills merely because you are treating with a “posted” physician. Insurance companies can and do refuse payment to such physicians, and if you have not been referred to the posted physician in accordance with the terms and conditions of your HMO coverage, the HMO will almost certainly decline to make payment, as well.
Willig, Williams & Davidson Workers' Compensation Lawyers
The workers compensation lawyers
at Willig, Williams & Davidson
have a deep knowledge of workers’ comp law. Our Pennsylvania attorneys use our workers’ compensation expertise and a broad client base to leverage the best possible results for our clients in Philadelphia, Pennsylvania and beyond. Our Workers’ Compensation Department provides advice, counseling and legal representation to sick and injured workers, to make sure that they receive 100 percent of the benefits required by law.