In the U.S. healthcare system, most Americans can generally choose their doctor of choice. However, this may or may not be the case for a workers' compensation injury. With rules varying from state to state, many injured workers are unable to have a say in who treats their injuries. This predicament can lead to challenging circumstances that could jeopardize an injured worker's treatment and endanger trust in their recovery process.
Although most injured workers would likely prefer their choice of doctors, approximately one-third of U.S. states, do not allow them to do so. Many opposed to allowing workers to select their doctor cite high costs as their primary concern. However, comprehensive independent reviews from industry leaders such as the Workers' Compensation Research institute (WCRI) have found "essentially no difference in average medical costs between states where policies give employers control over the choice of provider and states where policies give workers the most control of the choice of provider."
The choice of provider by an injured worker or employer can differ by state. While some states allow injured workers to choose their physician outright, others may allow choice of physician after an initial visit. For employers who are able to select the injured worker's physician, some may, rather than designate an individual doctor, provide a list of preferred physicians the injured worker may choose from. Regardless of the employer or injured worker's choice, several states require the physician treating the injured worker to be in a network or MCO. With differing levels of choice or authority on the matter, injured workers can be easily confused by existing rules and statutes. To simplify this subject, see below for your state's laws and regulations regarding workers' choice of a physician for workers' compensation claims.
U.S. STATES:
Alabama: Employer selects physician.
Alaska: Injured worker chooses physician.
Arizona: Injured workers retain choice of physician in general. However, employer can choose physician for first visit. Self-insured employers are allowed to choose physician for injured workers.
Arkansas: Employer selects physician.
California: For the most part injured workers can select their doctor. However, if an injured worker did not pre-designate a doctor (before injury occurs) the claims administrator has the right to select doctor for first 30 days. After 30 days injured workers may be treated by a physician of their choice.
Colorado: Workers have flexibility to choose the doctor of their choice with restrictions. Injured workers must choose from a list of designated physicians from their employer. If no list exists injured worker may choose any physician.
Connecticut: Injured workers do have some say in their choice of doctor. The state allows employers to choose the medical facility for treatment, but worker selects treating physician from such facility. If an employer participates in an MCO, then the employee must select provider from the plan’s list of eligible physicians.
Delaware: Injured workers choose physician.
Washington, District of Columbia (D.C.): Injured worker chooses physician.
Florida: Injured workers can see doctors authorized by their employer’s insurance carrier.
Georgia: Injured workers must select from list provided by employer.
Hawaii: Injured workers choose physician.
Idaho: Employer selects physician.
Illinois: If a PPP is established employers may choose physician. If no PPP exists injured worker may select provider.
Indiana: Employer selects physician.
Iowa: Employer selects physician.
Kansas: Employer selects physician.
Kentucky: Injured workers do have limited choice within the state. If part of MCP the employee can select from participating medical providers.
Louisiana: Injured worker chooses physician.
Maine: Employer may choose physician for first 10 days of treatment, after such the injured worker can change to provider of their choice.
Maryland: Injured worker chooses physician.
Massachusetts: Injured worker chooses physician. However, certain plans can direct employee to a PPO provider for their initial appointment.
Michigan: Injured worker can choose provider after 28 days and must notify employer/insurer in writing.
Minnesota: Injured workers may generally choose physician. If employer operates an MCO, they can choose the physician. However, injured workers may be exempt to this if there is already an existing physician relationship.
Mississippi: Injured worker chooses physician.
Missouri: Employer selects physician.
Montana: Injured worker selects physician generally. However, insurer may designate their own doctor after initial treatment or allow injured workers choice.
Nebraska: Injured worker allowed to choose their current doctor. If no physician choice is made by injured worker, the employer provides a list to injured workers from which they may choose provider.
Nevada: Employer generally selects physician.
New Hampshire: Injured workers may choose their doctor unless employer/insurer operates an MCO. In which case worker must select from a participating provider.
New Jersey: Employers may select physician.
New Mexico: After 60 days injured worker may choose doctor.
New York: If within a PPO an injured workers may choose any provider authorized by NY Workers’ Compensation Board (NYWCB) 30 days after initial visit. If not in a PPO, injured workers can change providers at any time.
North Carolina: If in an MCO, injured worker can choose their doctor within network. If no MCO exists employers may choose physician.
North Dakota: Injured worker may utilize doctor they have designate (pre-injury). If no designation exists employer selects physician.
Ohio: Injured workers can choose their physician for the initial visit. After initial visit injured worker must choose Bureau of Workers’ Compensation (BWC) certified provider.
Oklahoma: Employer selects physician.
Oregon: Injured workers can choose their physician. If an MCO from employer/carrier exists, injured worker must select from participating providers.
Pennsylvania: Injured worker Is required to select provider from list given by employer within 90 days. If no list is provided, injured worker may choose physician.
Rhode Island: Injured workers choose physician.
South Carolina: Employer selects physician.
South Dakota: Employer selects physician.
Tennessee: Injured worker selects physician from list provided by employer.
Texas: Injured workers may choose physician.
Utah: Injured workers must choose from preferred provider plan in place. If no plan exists injured workers may choose their physician.
Vermont: Injured worker may change providers at any time after initial visit by filing a written notice.
Virginia: Injured worker selects from panel list designated by employer.
Washington: Injured workers choose their physician. However, will need to see provider in network after first visit.
West Virginia: Injured worker can choose physician unless employer operates an MCO. In such case, injured worker must select from participating providers.
Wisconsin: Injured workers can choose physician.
Wyoming: Injured workers can choose physician.
