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Pennsylvania Workers’ Compensation: Do I have to treat with the panel doctor?

QUESTION:

I DON’T HAVE ANYTHING EXACTLY AGAINST THE INSURANCE COMPANY’S DOCTOR, BUT I’D LIKE TO GET TREATMENT FROM MY DOCTOR WHO HAS ALWAYS TREATED ME IN THE PAST FOR THE SAME CONDITION. THAT’S NOT A PROBLEM, IS IT?

ANSWER:

Unfortunately, under Pennsylvania law, it is a problem. Pennsylvania law is very specific with regard to what doctors you are allowed to obtain treatment from after being injured at work. Specifically, the Pennsylvania Workers’ Compensation Act indicates that for the first ninety (90) days after your work injury, you are required to treat with the company’s/the insurance carrier’s doctor. Most employers have a panel physician list, which is a list of doctors/organizations where an injured worker can obtain medical treatment. All initial treatment must go through these particular physicians. These doctors will control the treatment received, etc., for the first ninety (90) days. After the initial ninety (90) day period expires, you are permitted to treat with any doctor you choose. At that point, you would simply submit the insurance carrier information/ claim number to the new physician, so that the insurance company is properly billed for the treatment rendered to you after the ninety (90) day mark.

It is important to note that, technically, you are allowed to treat with any doctor you want to after you are injured at work. However, the insurance company is under absolutely no obligation to pay for medical treatment received from your family doctor or any other physician that is not a panel doctor, if that treatment is obtained within the first ninety (90) days. In other words, you can go to a different doctor, but the insurance company is not required to pay for that treatment if you are still within the first ninety (90) days after your work injury. If you would like to obtain treatment from a different physician, you will be on your own to pay for this medical treatment. It is unlikely that your private health insurance would cover any medical bills in this regard, if the treatment is for a work related injury.

If you choose to go to a new doctor or your family doctor for the injuries you sustained in a work accident, you should make sure to be very specific with these doctors as to how you were injured, your symptoms, body parts injured, etc. You must provide a completely accurate description of your work accident and injuries sustained. If you do not, it could lead to a denial of your medical bills and ultimately impact your Workers’ Compensation matter.

Finally, if your claim is denied by the Insurance Company or your employer, you can treat with any doctor you choose.

Additional resources provided by the author

If you have any questions, feel free to contact MHK Attorneys at the website listed below. You can also look for valuable information on the website for the Pennsylvania Bureau of Workers’ Compensation, which link follows: http://www.portal.state.pa.us/portal/server.pt/community/workers'_compensation/10386

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