Who decides the treatment plan for an injured worker?

On Behalf of | Dec 7, 2023 | Workers' Compensation

Getting hurt on the job is a massive inconvenience. A worker needs to report the matter to their employer and likely end their shift early to seek medical care. Depending on how severe the injury is, they might be unable to work for days or even weeks. They may require expensive medical treatments before they fully recover the ability to work. Thankfully, those with job-related health challenges in Pennsylvania can sometimes secure workers’ compensation benefits to help pay for their treatment.

They won’t have to cover some of the expense as they would if they used their own health insurance. However, there are rules that apply to workers’ compensation benefits that differ from the rules for standard medical treatment. For example, workers don’t usually get to select their own treatment. Who determines what care a worker receives?

A physician establishes the treatment plan

Neither the injured worker nor their employer should directly control treatment options during a Pennsylvania workers’ compensation claim. The physician overseeing the patient’s care is the party with the authority to establish a treatment plan. After a careful review of a worker’s symptoms, a medical doctor can then determine what treatment will offer them the best prognosis and the most rapid return to work. The worker will then need to comply with that treatment plan by attending physical therapy, taking medication and otherwise receiving the treatment that a doctor deems necessary.

Occasionally, workers may disagree with the recommendations of a physician. They would then need to seek a second opinion to avoid becoming non-compliant with medical instructions. Workers’ compensation will cover the cost of a second opinion if the recommended course of treatment involves surgery. Otherwise, workers may have to pay out of pocket for a second opinion and then use the report from another doctor to facilitate additional discussions with the doctor overseeing their treatment. In some cases, it may be necessary to have another doctor take over someone’s care or to appeal a decision that would end someone’s benefits.

Those facing a lengthy recovery and invasive treatments may require help when negotiating a treatment plan and trying to assert their rights. Learning more about the rules that govern Pennsylvania workers’ compensation benefits may help people get the care they need while coping with a job-related health challenge.