Step 3 Develop Your Company’s Provider Panel

PROVIDER PANEL DEFINED

The PA Workers’ Compensation Act gives employers the right to establish a list of designated health care providers. When the list is properly posted, injured workers must seek treatment for the work injury or illness with one of the designated providers for 90 days from the date of the first visit. There are some specifics provided in the rules and regulations found in title 34 of the Pennsylvania Code for these lists.

If a designated list is established, the employer must provide a clearly written notice to an injured employee of the employee’s rights and responsibilities. Section 127.755 of 34 Pa. Code provides specific instructions concerning when and how the notice is to be provided to the employee.

Employers may not require treatment with any one specific provider on the list, nor may the employer restrict the employee from switching from one designated provider to another designated provider. The employee is free to choose any provider on the list.

If there is an emergency situation, the employee is not required to obtain emergency treatment from a listed provider. However, once the emergency condition no longer exists, the injured employee shall seek treatment with a listed provider.

If an employer chooses not to establish a list of designated providers, the employee has the right to seek medical treatment from any provider of his or her choice.

More details regarding Employers Panel Provider Requirements.

Further details on the list of designated providers and its correct use are contained in Subchapter D, 34 Pa. Code Sections 127.751 through 127.755 of the rules and regulations found on page 196 of the Workers’ Compensation Act as revised and reprinted in 1999.

Designated List of Health Care Providers:

• The list must contain at least six providers
  
  
• Three of the six providers must be physicians
  
  
• No more than four providers may be coordinated care organizations
  
  
• Each provider’s name, address, telephone number and area of medical specialty must be included on the list
  
  
• Listed providers must be geographically accessible and their specialties appropriate for the anticipated work-related medical problems of the employees