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How to Count to two Medical Providers

The Workers’ Compensation Act allows an injured worker to select two chains of medical providers at the employer’s expense provided that the services are reasonable and necessary. To illustrate, an employee may choose to consult with Dr. X relating to a work connected injury. Dr. X may refer the employee to a specialist, Dr. Y, for further treatment. Because Dr. X referred the employee to a second medical provider, Dr. X and Dr. Y count as one choice under the Workers’ Compensation Act. Then, if the employee on his own, elects to consult Dr. Z, the employee has now exercised his second choice and thereafter, must use Dr. X and his referrals or Dr. Z and his referrals. Any physician in the chain can refer the worker to any other specialist or medical provider without counting that provider as a new choice. If the employee elects to consult a third doctor or chain, it will be at the employee’s own expense – two “chains” of doctors are all that the employer is obligated to pay.

What happens if the employee treats with more than two chains of providers, with one of the medical providers giving only minimal treatment at minimal cost? May the worker insist that the company pay for the two expensive providers and the employee pay the other, less expensive, doctors? The answer is “No”.

The employer need only pay for the first two chains of medical providers. The employee cannot choose which of the physicians are to be considered his first and second physician choice. Thus, the employer does not have to pay for the bills of providers after the first two chains, even if the employee would not seek payment for some of the medical providers who had rendered earlier, less expensive, medical services. However, treatment in an emergency room does not count against an employee as a choice of a medical provider.

It is important that injured employees know their rights under the law, particularly as to the limitations imposed on the number of medical providers. The employee must be extremely careful in the selection of doctors consulted.

Nothing said here applies to medical providers chosen by the employer. Remember, an injured worker is not obligated to treat with a physician chosen by the employer.

If you have any questions on this subject, please contact us.