The bill has strong backing from House Republicans and the business community, including the Pennsylvania Chamber of Business and Industry. However, many oppose the proposal, saying it would effectively eliminate an individual’s right to choose his or her doctor.
Pennsylvania Workers’ Compensation Law
The Pennsylvania Workers’ Compensation Act offers two main benefits to injured workers: compensation for wages employees lose while off work due to injury and payment for medical treatment for their injuries.
Total Disability Benefits
An employee who sustains a work-related injury is entitled to wage-loss workers’ compensation benefits until he or she can go back to work. If the worker is unable to return to work because of his or her injury, the employee may qualify for total disability benefits equal to two-thirds of the worker’s average weekly wage. Also, if the worker is more than 50 percent disabled as determined by American Medical Association standards, the worker may qualify for total disability benefits. An injured worker can collect total disability payments for up to 104 weeks, as long as the employee remains disabled.
Partial Disability Benefits
If an injured worker does not meet the 50-percent disabled threshold for total disability benefits, the worker may be entitled to partial disability benefits for up to 500 weeks. The amount of time an injured worker collects total disability payments does not count toward the 500-week limit if he or she also receives partial disability benefits later.
Wage-loss benefits start after an injured worker has been disabled for seven calendar days. Benefits begin for time missed from work on the eighth day of disability, and if the disability persists for more than 14 days, workers’ compensation retroactively compensates the injured worker for the first seven days of the injury.
In addition to wage-loss benefits, an injured worker is entitled to payment of reasonable surgical and medical expenses for treatment of the injury, including:
- Hospital care and services
- Orthopedic appliances and prosthetic devices
Current Doctor-Choice Rules
Currently, the Pennsylvania Workers’ Compensation Act requires an injured worker to choose a doctor from a list of health-care providers selected by the employer. Employers must provide a list of at least six health-care professionals, at least three of whom must be doctors and no more than four of whom may be associated with a coordinated-care organization. After the employee chooses a provider from the list, the employee must continue to see that doctor exclusively for 90 days from the date of the first treatment; otherwise, workers’ compensation is not obligated to pay the bills for the worker’s treatment.
If the doctor from the list recommends invasive treatment or surgery, the worker has the right to seek a second opinion from any physician, not just a provider on the list. However, if the second-opinion doctor proposes a different treatment plan and the injured employee decides to use the alternative scheme, the employee must seek that treatment from a provider who is on the list within the 90-day timeframe. After 90 days have passed, the worker is free to continue treatment with any health-care provider he or she chooses.
Effects of the Proposed Change
H.B. 808 would double the time an employee is required to see a health-care provider from an employer’s list to 180 days from the first treatment date. Critics of the measure, such as the Pennsylvania Chiropractic Association, argue that increasing the mandated treatment time with the employer-chosen doctor will only extend the time it takes an injured worker to heal and return to work as well as increase health-care costs for employers and their insurers. Further, it would also rob injured employees of their choice in of one of the most personal relationships a person has: the one with his or her doctor.
This workers’-compensation legislation proposed to lengthen the amount of time an injured worker must see an employer-chosen doctor is detrimental to injured employees. If you have suffered a work-related injury, contact an experienced workers’ compensation attorney at Krasno Krasno & Onwudinjo today at (215) 223-6718 to discuss your legal rights and options.