Do I Have to Treat With the Company Doctor in Pennslyania (PA)?

Employer do not have to have a posted panel list of physicians for injured workers to treat with for the first 90 days of treatment. When there is no list an injured worker can treat with a doctor of their own choice from day one and workers’ compensation is responsible for the treatment bills. Likewise, If there is an invalid list, an injured worker can treat with a doctor of their own choice from day one and workers’ compensation is responsible for the treatment bills. If there is a valid list, then the compensation carrier only has to pay the bills for the first 90 days of treatment if the treatment is with a listed provider.After the 90 days of treatment, whether on or off the list, the workers’ compensation carrier is responsible. Those employers that choose to utilize a posted list are doing it to control the injured worker by limiting their choice of medical providers. Too many doctors are more than willing to appease the employer by keeping costs down to keep a steady stream of patients flowing in off the posted list. As a result, too often the injured workers’ health becomes a secondary interest. Proper testing for diagnosis is foregone and releases to return to work are too often mandated before the injured worker is physically capable which only subjects the worker to further unnecessary injury. In addition, employers use the 90 day treatment period in conjunction with the issuance of a Temporary Notice of Compensation Payable. On the 89th day the company doctor releases the employee to work and the Temporary Notice of Compensation Payable is revoked on the 90th day which relives the employer from paying any further medical or wage loss benefits and the injured worker must file a Claim Petition and litigate it or forever lose their rights to workers’ compensation for that injury. Most never realized that the failure to treat with the properly posted company doctor is not a valid reason to deny a wage loss claim.

For those employers seeking to ration and control an injured workers medical choices, the Pennsylvania Workers’ Compensation Act provides minimal safeguards by requiring such employers to:

  1. Post a list of at least six (6) health care providers;
  2. At least three (3) must be physicians;
  3. No more than four can be coordinated health care organizations;
  4. Not include on the list any provider that is employed, owned or “controlled” by the employer or carrier unless that information is disclosed; and
  5. Provide the injured worker with and have them sign a written “Acknowledgment of Rights and Duties” with respect to treating with company doctors both before AND after the work injury;
  6. Provide the name, address phone number and specialty of the listed providers;
  7. Provide on the list only providers who are geographically accessible. See Section 127.752 (c); and
  8. If the employer lists a CCO, the employer may not individually list any provider participating in that CC, under circumstances when those individually listed are bound by the terms of the CCO for the treatment rendered to the injured worker.

Failure to comply with any of the above 8 requirements renders the company posted doctor list invalid and requires the workers’ compensation carrier to pay for all treatment from day one with any provider the injured worker chooses.