GET THE LIST!
When I sit down with a prospective workers’ compensation client, one of the first questions I ask them is where they initially treated for their work injury. If the answer is one of the local “work injury processing plants,” which will remain nameless in this article, my next question is why did they choose to treat there. Almost always, the client tells me that this is where they were specifically told to seek medical treatment by their employer or its workers’ compensation insurance company, and they were not given the option to treat elsewhere.
Pennsylvania’s workers’ compensation law very clearly sets forth that, once an employee gives notice of a work injury to their employer, certain duties and obligations on the part of the employer are triggered. One of these obligations is to immediately provide the employee with a copy of the employer’s panel list of workers’ compensation healthcare providers. This list must contain the names of at least six medical providers, each from different disciplines of healthcare. For instance, a compliant panel list could have the names of an emergency care provider, a primary care physician, an orthopedic surgeon, a physical/occupational therapist, a chiropractor and a general surgeon.
If the panel list does not contain the name of a medical provider within the discipline necessary to treat the injured employee, then the worker may seek out treatment with such a provider of their own choosing, and it will be the responsibility of the employer or workers’ compensation carrier to pay for the treatment, provided it is reasonable, necessary and related to the work injury. Thus, for example, if an employee suffers a low back injury and would like to treat with a chiropractor, if there is not a chiropractor on the employer’s panel list, the employee may treat with a chiropractor of their choice.
What an employer or its workers compensation insurance company is not allowed to do is compel an injured employee to seek treatment at a specific provider or facility. I mentioned “work injury processing plants” above, because these are the most common facilities where employers inappropriately try to send employees hurt on the job to treat. Of course, this begs the question, “Why these places?” In my years of experience representing the injured workers of Lancaster County, I have come to observe that these facilities, while not formally associated with local businesses, certainly seem to have very open lines of communication with them. I have also seen numerous instances where it appears that the cost of the treatment in question and/or the wishes of the employer are more determinative of whether or not the treatment will be prescribed for the employee than the actual medical necessity of the treatment. Both of these reasons can be, and usually are, inconsistent with treatment and care that is in the best interest of the patient.
So, while our workers’ compensation law says one thing, many employers and their insurance carriers often do another—and I guarantee you that the motivating factor is not the welfare of the injured worker. Therefore, if you have suffered an injury on the job, get the list. It is your absolute legal right.
