Pennsylvania Workers’ Compensation Benefits – Getting Medical Treatment

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Individuals injured at work or suffer work related injuries often want to know how their medical bills get paid. Pennsylvania Workers’ Compensation laws require most employers to provide workers’ compensation benefits to employees. Therefore, an injured worker would be able to obtain medical treatment, so long as the employer maintained workers’ compensation insurance and assuming other workers’ comp eligibility requirements are met.

PA Workers’ Compensation Medical Benefits – Who Can You Seek Treatment With?

Under Pennsylvania Workers’ Compensation law, employers are allowed to designate medical treatment providers for injured employees.  The law allows employers to create a list of medical treatment providers. As long as the list is clearly posted, injured workers are required to seek treatment from providers on the list for the first 90 days after the date of the first treatment visit.

In addition, employers must adhere to certain guidelines per the PA Workers’ Compensation Act:

• The employer must provide a clearly written notice of the employee’s rights and duties.
• The notice must be provided to and signed by the employee at the time of the accident/injury.
• The list must contain at least six providers; three of the six providers must be medical doctors.
• The employer may not force the injured employee to choose any specific provider on the list.
• The injured employee may switch from one designated provider to another designated provider.
• If employer’s list of designated providers fails to comport with the Act and the regulations, the employee has the right to treat with a provider of his or her choice.

In some work accident cases, the injured worker will need to treat with a specific type of doctor. If the list of providers does not contain medical treatment providers for that specialty, and the specialty care is reasonable and necessary for treatment of the work injury, the injured worker will be allowed to treat with a health care provider of his or her choosing. See Martin v. WCAB (Emmaus Bakery), a 1995 Pennsylvania Supreme Court case which held in favor of the employee on the issue of specialty care. Click here to see the Pennsylvania Department of Labor & Industry guidelines re: PA workers’ compensation medical treatment provider lists.

PA Workers’ Compensation Medical Benefits – Can You Seek Treatment With Your Own Doctors?

Most individuals who are injured at work and need extensive or prolonged medical treatment do not know that they have a right to see their own medical doctors, after 90 days from the date of the first medical visit. Under the PA Workers’ Compensation Act, after 90 days, injured workers are allowed to see their own doctors. However, the injured worker must provide notice to the employer within 5 days of the first visit. See Section 306(f.1) of the PA Workers’ Compensation Act.