Injured Workers in PA Only Bound by Properly Posted Panel

There is a common misconception that the workers’ compensation insurance carrier controls medical treatment whenever a worker is injured in Pennsylvania.  This is addressed in broad strokes on our website.  The truth is, a workers’ compensation insurer in PA may control medical treatment for the first 90 days of an injury, only if certain requirements are met (and very often, they are not).  Even then, there are situations where the injured worker is not bound by the insurer’s desired healthcare providers.  As with many aspects in the complex world of PA workers’ comp, it pays for an injured worker to know his or her rights.

An employer may post a “panel” of healthcare providers for an injured worker to use in the case of a work injury.  For a panel posting to be valid, it must include at least six healthcare providers (at least three of which must be physicians).  No more than four of the healthcare providers can be part of a coordinated care organization.  Though it may seem obvious, the providers must be geographically accessible for the injured worker.  The panel listing must contain the name and specialty of each provider, the address and phone number, and any ownership relationship.

Those requirements are just pertaining to the content of the panel posting.  For a panel posting to be valid and binding, more is required.  The panel must be “conspicuously” posted in an employee-accessible area (such as a breakroom, locker room, first aid station or time clock area).  Additionally, employees must receive a written copy of the panel at the time he or she is hired, as well as either immediately after, or as soon as possible after, an injury.

If, and only if, each of these requirements is met, then the workers’ compensation insurer may only need to pay for treatment with a listed healthcare provider for the first 90 days after an injury.  Importantly, neither the employer, nor the insurance carrier, can direct the injured worker which panel provider to use.  After the 90 days elapses, then the injured worker has the choice of whether to continue treating with the panel provider, or choose a provider of his or her own.

Even if the employer has a properly posted panel, and meets all of the above requirements, there are situations where an injured worker may still treat with a healthcare provider not listed on the panel (and the workers’ comp insurer would be liable for payment).  These situations include emergencies, when a desired specialty is not represented on the panel, when invasive treatment (such as surgery) is recommended, and when a panel provider refers the injured worker to a provider who is not listed.

As you can imagine, this can get complicated and confusing.  And, that is one of the many reasons we recommend that injured workers seek legal advice as soon as possible after a work injury (if only to learn his or her rights).