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Know the rules about choosing a medical care provider

Employers with one or more employees in Pennsylvania must have workers’ compensation insurance in place, even for part-time and seasonal workers. This will pay your medical expenses if you should suffer an on-the-job injury or contract a work-related illness. Furthermore, it will pay a portion of the wages you lost if you were unable to return to work immediately. You may also find comfort in knowing that your dependents will receive similar coverage if you do not survive a workplace accident.

However, you may be one of many employees who have questions about the regulations connected to the medical care and choice of care providers. Some occupational injuries require ongoing treatment, and confusion sometimes exists about the coverage of related medical expenses.

Rules related to medical benefits

You will receive benefits to cover medical expenses from the first day of the injury. However, the following rules apply to the choice of doctor:

  • Employer approved health care providers: Your employer may provide a list of at least six physicians from which you must choose to provide the necessary health care — without direction by your employer. You must continue treatment under the selected physician — or another one on the list — for the first 90 days. If you need further treatment, you will be free to go to a doctor of your choice. If your employer does not post such a list, you may choose your own physician from the start.
  • Your right to a second opinion: If the employer-approved physician suggests invasive surgery, you may seek the opinion of a doctor of your choice at the expense of the insurer or your employer. However, if you choose to follow the treatment suggested by the doctor who provided the second opinion, one of the listed physicians must provide that care if it falls within the 90-day period.
  • After 90 days: If you choose to go to your own doctor after 90 days, or if your employer never had a list of preferred health care providers, you must inform your employer of the name of your chosen doctor. Your employer or the insurance company may request monthly medical reports from your doctor.
  • The risk of suspension: If you are under the care of your own doctor at the expense of the insurance company, your employer may ask you to undergo a medical examination by a nominated physician. Refusal to comply may lead to suspension of your benefits. The same will apply if you refuse treatment by one of the listed doctors for the first 90 days.
  • Included medical coverage: The benefits will cover reasonable medical and surgical services necessary for treatment of occupational injuries or illnesses with some limitations for certain lung diseases. This will include all medicines and medicinal supplies, hospital services and treatment and doctors’ fees. Furthermore, it will pay for prostheses and orthopedic appliances that you might need. Workers’ compensation insurance will cover all medical expenses, even if you were able to return to work immediately after the incident that caused your injury.

If you have questions about your rights under the Pennsylvania Workers’ Compensation Act, you will find the answers with an experienced workers’ compensation attorney who can also assist with the navigation of your benefits claim or an appeal if your claim was denied.

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