One of the more commonly misunderstood aspects in the Pennsylvania Workers’ Compensation Act is the status of medical treatment within the first 90 days of the injury. Too often, an injured worker will be told by his or her employer that they must treat with a specific company doctor. This is not completely true, according to the Pennsylvania Bureau of Workers’ Compensation.
If the employer follows the requirements of the Pennsylvania Workers’ Compensation Act, and properly posts a listing of healthcare providers (not necessarily doctors, more on that later), the employer is only required to pay for treatment with those listed healthcare providers for the first 90 days of treatment after a work injury.
To have the listing of healthcare providers (known as a “panel posting”) be “proper,” the list must meet certain requirements. For one thing, there must be at least six healthcare providers on the list, of which at least three must be doctors. The names, addresses, telephone numbers and specialties of each healthcare provider must be stated as well. The healthcare providers on the list must be “geographically accessible.” The list must be prominently displayed, and the employer must have the worker sign a document acknowledging that the worker saw the list at the time the worker is hired, after a change is made on the list, and after the injury.
If the listing is “proper” and the employer has followed the requirements listed above, then the workers’ compensation insurance carrier is only required to pay for treatment with those listed healthcare providers for the first 90 days of treatment. The injured worker is free to choose any healthcare provider on the panel (the employer cannot direct the injured worker to any specific healthcare provider). If the injured worker needs treatment from a specialty which is not represented on the listing, the injured worker is free to choose his or her own healthcare provider in that specialty, and the workers’ compensation insurance carrier is responsible for payment (provided the treatment is reasonable, necessary and related to the work injury).
It is also important to note that, even if the employer has a properly posted listing, the only penalty to the injured worker for going to a doctor not on the listing is that the workers’ compensation insurance carrier will not be required to pay for that treatment. There may be situations where the injured worker finds seeing his or her own physician, perhaps just a single time, worth paying the cost of the visit.