Can My Employer Force Me to See Their Doctor in Pennsylvania?

Workers’ Compensation benefits can cover the cost of treating your injuries no matter how serious they are.  They also pay you back for a portion of the wages you miss during your recovery or while suffering from a disabling injury.  However, there are some concessions you may need to make, including choice of doctor – at least for a limited period.

The Pennsylvania Workers’ Compensation Act allows employers or their insurance carriers to choose a list of care providers that they can require you to see for medical care within that provider’s area of practice.  They can only make you use that doctor for the first 90 days of care, but you may need to see other doctors during this period to receive tests and examinations to prove your claim in the first place.  Additionally, you can often choose your own doctor after 90 days, and even within the first 90 days if you need to see a specialist or you want a second opinion on surgery.  After 90 days, you can typically choose your own care provider.

Call (267) 651-7945 today for a free case assessment with Cardamone Law’s Certified Pennsylvania Workers’ Compensation Lawyers.

Do I Have to See My Employer’s Chosen Doctor for Workers’ Compensation in Pennsylvania?

First and foremost, we want to emphasize that no one can ever force you to see a doctor you do not want to see or receive medical care you do not want.  If you are willing to pay for it yourself and forego Workers’ Comp benefits, you can see whatever doctor you choose.  However, making the sacrifice of using a doctor chosen for you is often worth it when it opens access to having all of your medical care paid for, plus receiving benefits for your lost earnings and specific losses through Workers’ Comp.

Otherwise, the Workers’ Comp Act gives employers and their insurance carriers the right to select a list of doctors that you have to choose from – with exceptions – for the first 90 days of your covered medical care.

What Doctors Are on My Employer’s Workers’ Comp Care Provider List?

Employers choose a list of at least six care providers that they can require you to see for covered medical care.  These care providers must certainly be medical professionals, but they are not necessarily all doctors, and they might not all practice the right type of medicine for your particular case.

Up to four of the doctors on your employer’s approved list can be from a “coordinated care organization,” defined under 34 Pa. Code § 122.602.  These are essentially “Workers’ Comp doctors” who must still have proper licensure to treat patients and need to have sufficient ability to refer out patients who they cannot adequately treat.  Even so, these care providers often perform most of their care on injured workers and merely focus on getting them patched up and back to work rather than examining the whole patient or investigating further into injuries and potential disabilities.  As such, it is often better to choose a different care provider if one is available.

At least three of the care providers on the list need to be “physicians.”  This might mean M.D.s or D.O.s, as both would typically be called “physicians.”  Others on the list might have different levels of licensure, such as being physician’s assistants, nurse practitioners, or even specialists within certain fields.

Other care providers on the list will often include chiropractors, physical therapists, and mental health providers.  Keep in mind that the list has to include “at least six” providers, meaning they certainly can provide more options that give you some flexibility in choosing which providers to see to meet your needs.

When Can I Go Off the List of Approved Care Providers for Workers’ Comp in Pennsylvania

After 90 days, you can switch your care to whatever qualifying physician or other care provider you want to see.  As long as you continue to receive care to treat this injury, you can choose physical therapists, doctors, or whatever other care provider would be appropriate for your case.  This choice is yours, whether the doctor is on the list or not.

However, during the first 90 days when you are supposed to only be choosing providers from the list, you can go “off-list” for certain reasons, too.

First, if you need to see a specialist and that type of specialist is not represented on the list, you can choose your own specialist.  For example, you may need to see a neurologist for a head injury or an oncologist for cancer acquired at work.

Second, if you need “invasive surgery,” the Act allows you to get a second opinion from a doctor of your choice.  If your chosen doctor comes up with a different plan for surgery than the doctor from the list, you can choose which course of treatment to pursue, but it still needs to be carried out by a listed doctor if the surgery would be in the first 90 days.

If you go off list and it is not part of an exception or approved alternative, you risk losing coverage for your treatment.

Can I Trust Treating Physicians Chosen by My Employer Under Workers’ Comp?

In general, you need to be able to trust your doctor while receiving care for an injury.  This transparency and trust can help lead to better outcomes and recovery, and having a doctor you do not trust can really hurt your recovery.  However, there is a difference between trusting the doctor to provide adequate care and trusting the doctor with everything.

Listed care providers need to be adequate professionals who can provide medical care, so that should not be a concern.  However, you do not need to trust them to have your best interests in mind when it comes to getting you coverage.  These doctors are, ultimately, paid for by the insurance carrier, and the carrier usually wants to see your case over and ended without them paying for it.  As such, the listed physicians might try to deny that your injury was work-related or otherwise send you back to work before you are truly ready to go back.

Our lawyers can help arrange for you to see other specialists and doctors to prove your condition was work-related and that your injury is sufficiently disabling if this is challenged in your case.

Call Our Workers’ Comp Lawyers in Pennsylvania Today

Call Cardamone Law’s Harrisburg, PA Workers’ Comp lawyers at (267) 651-7945 for a free case assessment.