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You Shouldn't Have To Fight For Workers' Comp Benefits

How do I know if my employer’s provider list is legal?

In our previous post, we began looking at how workers’ compensation law addresses the issue of choice of provider. As we noted, employers in Pennsylvania are able to limit their workers’ choice of provider, but only if they provide a proper listing of providers.

What, then, constitutes a proper provider list? According to the Pennsylvania Department of Labor and Industry, the list must specify a minimum of six providers, three of which must be physicians. All the providers must be “geographically accessible” to workers. 

Several additional points about the physician list: it may not push employees toward consulting with any specific provider on the list, nor may employees be compelled to pick and stay with one provider on the list through the course of their treatment. Rather, injured workers must be permitted to switch from provider to provider if they so choose.

With regard to specialties, if providers with specialization are included, the specialties must be appropriate for the type of medical problems injured workers are likely to have.  Also, an injured worker who requires specialty care as reasonable and necessary for his or her work-related injuries is permitted to deviate from the list if no provider in the relevant specialty is provided by the employer.

As we noted, if these conditions are not met regarding the provider list, injured workers are not bound to the list and may seek treatment as they see fit. It is wise, though, to consult with an attorney before making any decisions which could impact one’s workers’ compensation coverage. That way the injured worker has the opportunity to make sure things are done correctly and that they don’t end up losing money and time.

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