Can You See Your Own Doctor on Workers’ Comp in Pennsylvania?

Workers’ Compensation pays for medical care to recover from a work-related injury, but there are often restrictions on this care.  While they might be limited in time, eventually allowing you choice of physician, there are often restrictions on what doctors you can treat with in the first 90 days of your care.

Under the Pennsylvania Workers’ Comp Act, employers are supposed to make a list of at least six care providers, and injured workers are required to treat with these care providers for the first 90 days of treatment.  This eventually allows you to see your own doctor – and there may be opportunities in the initial 90 days to see your own doctor if you need outside opinions or second opinions on surgery.  However, this restriction only applies to care for the injury; other check-ups and unrelated care can still be performed by your normal doctor.

For a free review of your claim, call Cardamone Law’s Certified Pennsylvania Workers’ Compensation Lawyers at (267) 651-7945.

Can I See My Own Doctor While I’m on Workers’ Comp in Pennsylvania?

When you undergo treatment for a work injury, the care usually needs to come from a doctor that your employer chose.  Employers are permitted to choose at least six care providers to put on a list that needs to be posted in your workplace.  Any care you receive for your work-related injury needs to come from a care provider on this list in order to get the care covered, but only for the first 90 days.

After 90 days of care passes, you are free to pick up and go to another doctor of your choice.  At that point, the restriction on choice of treating physician does not apply anymore.

Keep in mind, however, that this restriction only applies to care for your work injury.  If you have regular check-ups with your own doctor for an unrelated condition or you get sick or need other care while you are coincidentally receiving Workers’ Comp benefits, that care is not restricted in any way.  For example, if you have an annual physical appointment scheduled for 2 months after your injury, you can usually still go to that appointment without jeopardizing your Workers’ Comp benefits.  You merely have to pay for that outside care as you would normally.

In the first 90 days, any care you receive from outside doctors not on the list is typically paid for out of pocket.  However, there are some situations where you can ultimately get that care covered, even if your doctor is not on your employer’s list.

Exceptions that Allow You to Choose Your Doctor While on Workers’ Compensation in Pennsylvania

As noted above, you can see any doctor you want if you are willing to pay for it, but to get your care covered under Workers’ Comp benefits, the doctor you see has to be on your employer’s approved list of treating providers.  However, there are still some exceptions that allow you to see different doctors.

Specialists and Certifications

The list of approved care providers needs to include at least three physicians, and up to four care providers on the list can be “coordinated care organizations” – essentially “Workers’ Comp doctors” who see nothing but work injury cases for Workers’ Comp insurance carriers.  If you need treatment from a specialist whose area of practice is not listed, you can often go off-list to get that care.

For example, you might need a neurologist if you suffered serious brain injuries, or you might need an orthopedic surgeon for a spinal cord injury.  If your employer did not list these specialists, you can find your own.

Some injuries and conditions are only treatable by experts in certain fields of medicine, and it would be absurd if the Workers’ Comp Act required you to see a work injury doctor or a general practitioner for some of these treatments.  Fortunately, the law does provide an exception here.

Acquiring Additional Medical Evidence

You may also be able to see outside doctors – including your normal primary care provider – if you need to get outside medical evidence to prove your initial case.  If the physician you are treating with disagrees that your injury is work-related, our Pennsylvania Workers’ Compensation lawyers will need additional medical evidence to prove your case at the outset and get your benefits approved.  We can often set you up with appointments with outside physicians who will be able to attest that your injury was related to your job, and we can often pay for those appointments at the beginning.  Then, at the end of your claim, we can include a claim to reimburse those outside medical costs, even if they are with a doctor you selected.

Second Opinions for Surgery

Lastly, there is an exception that allows you to seek an outside medical opinion if your treating physician tells you that you need invasive surgery.  You can choose the doctor you go to for a second opinion, and your employer has to pay for it.  If their treatment plan is different from what your treating physician proposed, you get to decide which plan to go with.  However, the plan still needs to be carried out by a doctor on your employer’s approved list unless the surgery will be taking place after the first 90 days of treatment.

What Kinds of Doctors Does Workers’ Comp Cover?

As mentioned, your employer is required to include at least three physicians on their list of approved care providers, but the rest of the list can be other care providers.  Most lists will include at least one surgeon to cover surgical needs, and many employers will include therapists, chiropractors, and other types of care providers on their lists to get injured workers varied treatment.  However, the listed doctors will not always be right for treating your case, so be sure to discuss your treatment with your lawyers.

Call Our Workers’ Compensation Attorneys in Pennsylvania Today

For a free review of your injury case, call (267) 651-7945 today to speak with the Philadelphia Workers’ Comp attorneys at Cardamone Law.