The Pennsylvania Workers' Compensation Act permits an employer to establish a list of panel medical providers (commonly called “company doctors”) with whom workers injured on duty must treat for a period of up to 90 days from the date of first visit to the provider. As a practical matter, few employers fully comply with the requirements of this section of the law. The consequence, however, of not treating with a company designated medical provider is that an insurance company will often refuse to pay a claim, even though it is illegal to do so. You are entitled to use your own medical provider, even when there is a list of medical providers. The only consequence is that the workers' compensation insurance company will not be legally responsible for payment of medical treatment for the work injury during the 90-day period that you would otherwise be required to treat with the company doctor. They are not entitled to deny a claim merely because you've chosen to treat with someone other than a medical provider on the list. Be careful in dealing with a company doctor. Even in the rare instances when an employer has created a proper list of providers, you probably should be seen by your own doctor.
If the employer has not created a list of panel medical providers, the employee is entitled to seek treatment from a provider of his or her choice. To be relieved of the legal obligation to pay medical bills for medical providers not on the company list, the insurance company must prove that you signed a written acknowledgement of your responsibility to treat with a panel provider both at the time of hire and immediately after the injury occurred. If the employer's list does not include the specialty that is appropriate for your medical treatment, you may choose any medical provider in that specialty. For example, if chiropractic treatment is proper for your particular work-related injury and the list of panel providers does not include a chiropractor, the insurance company is responsible for payment of chiropractic treatment even during the 90-day period when you are required to treat with panel providers.
The following is a list of the legal obligations the employer must meet before you are required to treat with a company doctor:
1. Your employer must provide notice to you of your rights and duties with respect to treatment by company doctors.
2. This notice must be signed by you at the time of hire.
3. The employer's list must have at least six providers, and three of them must be physicians.
4. The providers can include physical therapy facilities, chiropractors, and others who are not physicians.
5. The list must contain the provider's name, address, telephone number, and specialty.
6. Your employer is not legally entitled to force you to treat with a particular provider on the list.
7. You are legally entitled to switch from one designated provider to another one on the list.
8. Any listed provider must be geographically accessible to you.
9. The list of providers must contain specialties that are appropriate for the types of work injuries you can anticipate in your job.
10. If the foregoing requirements are not met, you are permitted to treat with a provider of your choice.
The most commonly violated provision is the requirement that an insurance company or employer not direct an employee to a specific provider on the list. Many employers develop relationships with "primary care" occupational health facilities such as Workwell, WorkNet or Concentra. Many employers unlawfully direct employees who are injured on the job to a particular occupational health clinic. Many set up systems in which they direct an employee to a particular occupational health facility and permit the injured worker to get treatment by a specialist only if the occupational health facility makes a referral to a specialist. This all completely illegal. You have the right to choose from among the medical providers on the list.
Over the years, we at Fenner & Boles have developed a large database on the reputations of physicians and other providers who regularly appear on employer lists of panel providers. If you suffer a work-related injury, you have the right to choose from among the medical providers on the list, and you should exercise that right. Insist upon receiving a copy of the list of medical providers. Feel free to make a no-obligation call to our office with the names of the medical providers, and we can give you advice on which of the providers is likely to provide you with the best care and give you the benefit of the doubt.
This is important because though they strenuously deny this, company doctors are likely to resolve doubts in favor of your employer or the insurance company. If you are being paid benefits pursuant to a Notice of Temporary Compensation Payable, the insurance company reserves the legal right to deny responsibility for your work injury. At that point, you must file a claim petition if you wish to receive workers' compensation benefits. Many occupational health clinics provide medical treatment for 60 days, and then release that employee to return to work full duty despite the fact that they are not capable of doing so. Often the providers will claim that the employee's condition is not related to a work injury but is instead related to a pre existing condition. The fact that you never had any symptoms associated with that pre existing condition is not of any particular concern to many of these providers. After all, if they resolve doubts too many times in favor of injured employees, they are not likely to remain on the list of medical providers maintained by the employer. Large employers with lots or work injuries tend to have much greater control over the panel providers.
If you’ve suffered a work injury and you are receiving benefits pursuant to a Notice of Temporary Compensation Payable, you may want to take steps to protect yourself. You may want to read Chapter 2 of The Wounded Worker: Inside The Pennsylvania Workers' Comp Maze, which you can obtain by downloading the book here or order a free paper copy by calling (877) 959-1811.