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Whose Doctor Rules When It Comes to Pennsylvania Comp Benefits?

Posted On Behalf of Schmidt Kramer Injury Lawyers on Jun 02, 2013 in Workers' Compensation

It doesn’t have to be all-out war between you and the insurance company paying your Pennsylvania workers’ compensation benefits—but all too often, it feels that way. You recognize that you have to give up some control when somebody else is paying for your medical care, but the insurance company appears to want to regulate every detail about your life.

A special concern is the choice of health care providers. You need to feel comfortable with the doctor treating your body after a Pennsylvania workplace injury. In contrast, the insurance company that pays benefits on behalf of your employer would rather steer you to a familiar doctor—one who may not have a bias in your favor.

As Harrisburg workers’ compensation attorneys, we are accustomed to hearing our clients complain about the insurance company’s preferred healthcare providers. The insurance company may not have certain medical specialties covered, or may select physicians whose offices are unreasonably far from your house.

Is there a way to settle these conflicts? You bet! The Pennsylvania workers’ compensation law anticipates there may be disagreements about medical treatments, and the rules make provisions to settle those disputes.

The three phases of medical provider use for workers’ compensation recipients

In the time following your workplace injury, there are three distinct phases for where—and with whom—you may seek treatment.

Phase One: Emergency and urgent care

For most serious workplace injuries, you will be sent to the closest hospital emergency room, or in some instances sent to a specialty hospital that focuses on your type of injury. Even if you do not believe you suffered significant injuries, it’s prudent to report to an ER or urgent care facility to be examined; some grave complications do not display obvious symptoms for hours or days after the event. The medical facility will choose the most appropriate health care providers, based on your situation. Relax, and take the advice of the physician who is assigned to your case.

Phase Two: Your employer and the insurance company choose your treating physician

After emergency care is no longer needed, you would probably prefer to go to your family physician for follow-up care. That’s not how the workers’ compensation system works. Your employer should have posted a list of six preferred physicians in an area that employees can regularly see—for instance, in a break room. Choose one of those doctors because he will be treating you for this on-the-job injury for the next 90 days.

If you decide you don’t like this doctor’s treatment style, you are free to switch at any time to one of the other six preferred providers. If your employer has not posted a list of six preferred providers, then you are free to choose any doctor you wish for treatment and care.

You are, of course, free to spend your own money to see your regular primary care doctor during this three-month period. But the workers’ compensation insurance benefits will not pay for those visits. You may also want to check with your individual or group health insurance plan to see if your policy will cover visits to your family doctor that might relate to your workplace injury.

Phase Three: Choose anyone you like

After 90 days have passed, you are free to select any accredited health care professional to continue treatment of your work injury. The insurance company handling your workers’ compensation case will continue to pay your health care bills until you have reached the maximum possible recovery.

Contact a skilled health benefits lawyer in Harrisburg to preserve your rights

If you have been hurt in a Pennsylvania industrial accident or were injured on the job in any setting, getting direct access to skilled healers may be critical for your eventual recovery. You cannot afford to let insurance flunkies make penny-pinching decisions when your wellbeing is at stake.

If you are facing threats to cut off your workers’ compensation medical care, call Schmidt Kramer today at 717-888-8888 or 888-476-0807 toll-free. We can schedule a free, confidential case review to outline our legal strategy for your case. We can also send you a FREE copy of our book, Who Pays The Bills When You Are Injured At Work?—and we’ll even pay for postage.