If you’re injured on the job in Pennsylvania and you want to file a workers’ compensation claim, your employer does have the right to determine which physicians you can see — within limits.
Learning more about what limits your employer has to follow gives you the information that you need in order to keep control over your own medical care and future.
— In an emergency, you can seek medical care where necessary — you can’t be denied workers’ comp benefits for getting emergency medical treatment from a doctor or hospital that isn’t “employer approved.”
— Once the emergency has passed, you may have to see a doctor of your employer’s choosing for the first 90 days of treatment.
— Your employer can only enforce the 90-day rule if he or she has followed the appropriate regulations:
— The employer has to have established the list of health care providers prior to your claim and published the list where it can be easily seen and used by employees.
— There must be at least six health care providers on the list.
— No more than four of the health care providers on the list can be coordinated care organizations (CCOs), and your employer cannot designate a specific member of the CCO — only the CCO in general.
— The health care providers all have to be located reasonably close enough and have knowledge that relates to the type of injuries that a worker might experience on your job.
— You have an absolute right to a second opinion. During the initial 90-day period, you can switch from one provider on the list to another freely, at your employer’s expense. If you choose to seek a second opinion from a provider that’s not on the list, you have to pay for it — unless the health care provider is advising invasive surgery. In that situation, you can seek a second opinion from any health care provider of your choice at your employer’s expense.
— Once the 90-day initial treatment period is over, you can seek treatment or a second opinion from a provider of your own choice — no matter what your employer prefers.
If your employer is making it difficult for you to obtain the medical care to which you are entitled after a workplace accident, n attorney can help you learn more about your options.