State Specific Workers Compensation Guidelines Employer Direction of Medical Care

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1 Alabama - Employer/insurer choose the treating provider without restriction. The employer/insurer cannot change providers after the initial selection. The employee can change providers once. However, the employee must choose from a list of four physicians. (Article 3, Section ) Alaska - Employee choice. AK Administrative Code Title 8 Chap. 45 Sect. 82 Arizona - Employee choice, though the employer has a right to an initial examination with a provider of their choice. AZ Revised Statutes Title 23 Chap. 6 Article E Self-insured employers may direct care. Arkansas - Employer can direct for the first 30 days. Within an MCO, there is absolute direction. California - If employer or employer's insurer has not established a medical provider network (MPN) or health care organization (HCO), employee may choose treating physician 30 days after the initial injury. CA Labor Code 4600(c). If the insurer or a self-insured employer has a contract with a health care organization (Health Care Organization), the employer selects the health care provider, unless the employee has previously designated a regular treating physician. Employee has the right to change his physician at least once to another physician affiliated with the health care organization. CA Labor Code (a), (e). If employee is not receiving or is not eligible to receive health care coverage for non-occupational injuries, employee may change physicians 90 days after first reporting injury. If employee is receiving or is eligible to receive health care coverage for non-occupational injuries and has agreed to receive care from an HCO, employee may change physicians 180 days after reporting the injury. CA Labor Code (c). An insurer or employer may establish or modify a medical provider network (MPN) for the provision of medical treatment to injured employees. The implementation of an MPN allows for controlled medical treatment for the life of the claim. Regulations state that the employer can direct the first treatment visit. When the injured covered employee notifies the employer or insured employer of the injury or files a claim for workers' compensation with the employer or insured employer, the employer or insurer shall arrange an initial medical evaluation with a MPN physician in compliance with the access standards set forth in section of the MPN regulations. The insurer or employer shall notify the employee of his or her right to be treated by a physician of his or her choice within the MPN after the first visit with the MPN physician and the method by which the list of participating providers may be accessed by the employee. (MPN L.C et al, MPN regulations 9767) Employee may choose his regular treating physician if (1) employee has given written notice to employer prior to the date of injury that he has a regular treating physician (2) the employer provides a non-occupational group health plan and (3) physician agrees to be pre-designated. CA Labor Code 4600(d). Colorado - Employer directs initial treatment but attending physician can refer out to other physicians at will. Connecticut - Employer can direct treatment within an approved Medical Care Plan. If no MCP, employer can direct only the initial treatment.

2 D.C. - Employee has initial free choice. Change of treating physicians requires employer/insurer approval. Delaware - Employee has free choice of medical care throughout the life of the claim. (Title 19, Chapter 23, Subchapter II, Section 2323: Any employee who alleges an industrial injury shall have the right to employ a physician, surgeon, dentist, optometrist or chiropractor of the employee's own choosing.) Florida - MCA Employer selects initial treating physician. Employee has the right to select a primary care provider from the MCA network. Employee, through written request, can change treating providers one time during the life of the claim. (Title XXXI, Chapter 440, Section 134) Non-MCA Employer selects treating physician. Employee, through written request, can change treating providers one time during the life of the claim. (Title XXX1, Chapter 440, Section 13.) Georgia - Employer must offer a panel or use an MCO option. Employer has total direction with a posted panel. Panel must consist of at least six providers, of which at least one must be an orthopedic surgeon, no more than two industrial medicine clinics, and where feasible, offer a minority. (Providers cannot be associated through practice/group.) Employee can change treating physicians to another provider on the panel. MCO option allows the injured worker to treat with any doctor in the MCO provider list. (O.C. G. A ) Hawaii - Employee has a free selection of medical treatment. Employer can get an IME, but this is limited. HI Revised Statute Chap. 386 Sect. Part II (b) Idaho - If claim is directed at the beginning, this can continue. Employer has the right to direct medical care. If not done at the start of the claim, then it is Employee choice for the remainder of the claim. If employee wants to change from the directed provider, we provide a list for them to choose from. Employee can formally request a change from the state. ID Statute Title 72 Chap Illinois - The claimant has free choice of all treating physicians from primary care to specialist. If claimant is unhappy with 1st choice, he may make a second choice as well. All physicians within a single chain of referral count as one choice. Employer has no control whatsoever. Indiana - The employer/insurer chooses the treating provider. With the exception of emergency services, all medial care services must be authorized by the employer/insurer. The employee is liable for the bills of any unauthorized provider. The WC Board can order the employer/insurer to pay for unauthorized care if it determines that the employer/insurer did not provider medical care. Iowa - The employer has the right to direct medical care. Kansas - The employee has free choice of medical care up to the first $500 in treatment rendered. Kentucky - Employees have free choice, but limited to two "gatekeeper" physician selections per claim. If employer participates with an approved MCO, employee's two gatekeeper choices are limited to MCO physicians. Subsequent referrals must also remain in network. Louisiana - Employee has free choice of medical care.

3 Maine - Employer can direct for the first 10 (ten) days post injury. Maryland - Employees have complete freedom of choice throughout the life of the claim. Most Employers will provide a panel of doctors for their employees to choose from. However, the employee has "free choice" of medical. (Labor & Employment Article, Title 9) Massachusetts Employee has free choice of medical care. Michigan - For the first 10 days following the beginning of medical care, the employer/insurer has the right to select the treating provider. After 10 days from the inception of medical care, an employee may treat with a physician of his/her choice by giving the employer the name of the physician and his/her intention to treat with the physician. Minnesota - The employee chooses the treating provider without restrictions unless the employer or insurer has contracted with a certified managed care plan, in which case the employee must go to selected treating provider. Mississippi - An injured worker has the right to select one physician or medical provider of his or her own choosing to render treatment. The chosen provider may make one referral of the worker to another specialist to continue treatment without any approval from the employer or its insurance carrier. The employer or its insurance carrier must approve any additional selections or referrals, in advance. The worker may choose a chiropractor. Missouri - The employer has absolute control of medical direction. Montana - Employee has choice of 1st treating physician. We can direct follow-up care. MT Title 39 Labor Chap. 71 WC Part 11 #01 Nebraska -In the absence of an employer managed care plan, the employee has free choice of physician.. Within the MCO, the employer has the right to direct referrals, but not first choice of physicians if already previously specified by the employee. Nevada - Employer can direct medical for the life of the claim. NV Revised Statutes 616C.010 New Hampshire - Employee has free choice of physician. If the employer participates in a Managed Care Organization then employee must choose their medical provider from within the MCO network. New Jersey - The employer can direct medical treatment for the life of the claim. New Mexico - The employer can elect to choose either direction of care for the first 60 days postinjury, or from day 61 on, for the duration of the claim. New York - Employer can direct for 30 days from initial treatment when enrolled in certified PPO. Otherwise, employee has free choice.

4 North Carolina - Employer has the right to direct medical care. If the employer denied liability or fails to provide treatment, or in the case of an emergency, the employee may select the physician or hospital, but must promptly request Industrial Commission approval. (Chapter 97 - Section 25) North Dakota - The employee has unrestricted choice of the treating provider, unless the employer is with an agency-approved risk management program. Employers with an agency-approved risk management program are allowed to select designated providers to treat injured workers. Employees may opt out of this requirement, however, prior to sustaining a work injury. Ohio - Employee has free choice of medical care unless self insured employer has a Qualified Health Plan (QHP) in place. In a QHP, employee must choose from the QHP network. The employee can switch to another QHP provider if he/she chooses. The employee may opt out of the employers QHP network and treat with a BWC certified physician after providing written documentation of their reason for the desired change. Oklahoma - Employer must initiate treatment within 3 days of knowledge of injury. If employer does not, employee may choose treating provider. Oregon - Non-MCO: 1. Employer can not direct care. 2. Employee can choose medical provider of their choice for life of the claim. 3. Employer does have the right to obtain an IME. Can have up to 3 IME's for each open period of the claim. 4. Employee can have up to 3 different opinions in each open claim period (not counting referrals from PTP). The claimants are allowed to designate a maximum of 3 attending physicians for the life of the claim (to prevent doctorshopping). Once #3 is reached, transfer of care must be approved by the case manager or by order of the Oregon Worker's Compensation Division. Employer can direct if employee is enrolled in the MCO. Employee may use non-directed provider until enrolled in the MCO. MCO enrollment is on a case by case basis. We currently do not have an MCO in place. Chap. 436 Div. 15 Sect. 30 Pennsylvania - The employer is required to post a listing of at least six (6) medical providers for the injured employee to choose from. The employee is required to treat with one of the listed physicians for 90 days from the date of first treatment. Rhode Island - Employee may choose first treating provider without restriction. Having a state certified PPN (Preferred Provider Network) allows direction into an approved network only if the employee wants to change treating physicians. South Carolina - The employer can direct medical care. (Title 42, Chapter 15, Section 60) South Dakota - The employee has the choice of the first physician, then the MCO can redirect after a window. The employee's physician, if not a part of the employer's MCO group, must abide by the MCO's treatment protocol and guidelines. Tennessee - Employer has the ability to direct if a panel is posted. Panel should consist of (3) physicians not associated with each other in the same practice. Panel must include a chiropractor in the event of a back injury. The chiropractor is limited to 15 treatments per injury. If a specialist is required, the physician may refer the employee; or, the employer may offer another panel of specialist from which to choose. (Tennessee Code )

5 Texas - Employee has free choice of medical, but limited to initial choice. Subsequent referrals are made through the treating physician. TWCC generally allows employee to change providers after filing for change with them. Employers who have obtained an Health Care Network (HCN) endorsement to their WC policy for TX and have completed the proper notification process may have their employees treat within the HCN. Employee is allowed one change of treating provider within requirements of the HCN but thereafter, must obtain permission of the HCN for any other change. Utah - Employee may change physicians once, but if it is to a non-ppo provider, must pay the difference in the fee. UT Labor Commission &8 Vermont - Employer has the right to direct the initial treating provider, but the employee can change providers by completing the State Form 8 Virginia - Employer is required to offer a Panel. The panel must have 3 providers of same specialty., not in the same practice group. Best if offered in writing and the employee verifies offer in writing. Failure to offer panel, results in employee having the right to chose his/her provider. (Code of Virginia, Title ) Washington - Monopolistic state. Employees have their own choice from a state approved physician list who handle WC cases. Revised Code of WA 51 Chapter Wisconsin - In a non-emergency, the employee selects without restriction a treating provider. In an emergency, the employer/insurer may select the treating provider. The employee is allowed to make a 2nd choice of medical practitioner at any time and for any reason. West Virginia - Employee has free choice of providers. Wyoming - The injured worker can choose their own physician. To change physicians, the employee must request in writing to the employer/carrier who authorizes or denies. Meds remain open for life unless they are settled. Ed. 08/15/2008