Subchapter D. EMPLOYER LIST OF DESIGNATED
PROVIDERS
Sec.
127.751. Employer’s option to establish a list of designated health care providers.
127.752. Contents of list of designated health care providers.
127.753. Disclosure requirements.
127.754. Prominence of list of designated providers.
127.755. Required notice of employe rights and duties.§ 127.751. Employer’s option to establish a list of designated health care providers.
(a) Employers have the option to establish a list of designated health care providers under section 306(f.1)(1)(i) of the act (77 P. S. § 531(1)(i)).
(b) If an employer has established a list of providers which meets the requirements of the act and this subchapter, an employe with a work-related injury or illness shall seek treatment with one of the designated providers from the list. The employe shall continue to treat with the same provider or another designated provider for 90 days from the date of the first visit for the treatment of the work injury or illness.
(c) The employer may not require treatment with any one specific provider on the list, nor may the employer restrict the employe from switching from one designated provider to another designated provider.
(d) An employe may not be required to obtain emergency medical treatment from a listed provider. However, once emergency conditions no longer exist, the injured employe shall treat with a listed provider for the remainder of the 90-day period.
(e) If an employer’s list of designated providers fails to comport with the act and this subchapter, the employe shall have the right to treat with a health care provider of the employe’s choice from the time of the initial visit.
(f) If an employer chooses not to establish a list of designated providers, the employe shall have the right to seek medical treatment from any provider from the time of the initial visit.
(g) If a designated provider prescribes invasive surgery for the employe, the employe may seek an additional opinion from any health care provider of the employe’s choice. If the additional opinion differs from the opinion of the designated provider and the additional opinion provides a specific and detailed course of treatment, the employe shall determine which course of treatment to follow. If the employe opts to follow the course of treatment outlined by the additional opinion, the treatment shall be performed by one of the health care providers on the employer’s designated list for 90 days from the date of the first visit to the provider of the additional opinion.
Source The provisions of this § 127.751 amended January 16, 1998, effective January 17, 1998, 28 Pa.B. 329. Immediately preceding text appears at serial page (203515).
§ 127.752. Contents of list of designated health care providers.
(a) If an employer establishes a list of designated health care providers, there shall be at least six providers on the list.
(1) At least three of the providers on the list shall be physicians.
(2) No more than four of the providers on the list may be CCOs.
(b) The employer shall include the names, addresses, telephone numbers and areas of medical specialties of the designated providers on the list.
(c) The employer shall include on the list only providers who are geographically accessible and whose specialties are appropriate based on the anticipated work-related medical problems of the employes.
(d) If the employer lists a CCO, as an option on the list of designated providers, the employer may not individually list any provider participating in that CCO, under circumstances when those individually listed providers are bound by the terms of the CCO for the treatment rendered to the injured workers.
(e) The employer may change the designated providers on a list. However, changes to the list may not affect the options available to an employe who has already commenced the 90-day treatment period.
Source The provisions of this § 127.752 amended January 16, 1998, effective January 17, 1998, 28 Pa.B. 329. Immediately preceding text appears at serial pages (203515) to (203516).
§ 127.753. Disclosure requirements.
(a) The employer may not include on the list of designated health care providers a physician or other health care provider who is employed, owned or controlled by the employer or the employer’s insurer, unless employment, ownership or control is disclosed on the list.
(b) For purposes of this section, ‘‘employer’s insurer’’ means the insurer who is responsible for paying workers’ compensation under the terms of the act.
§ 127.754. Prominence of list of designated providers.
If an employer chooses to establish a list of providers, the list shall be posted in prominent and readily accessible places at the worksite. These places include places used for treatment and first aid of injured employes and employe informational bulletin boards.
§ 127.755. Required notice of employe rights and duties.
(a) If a list of designated providers is established, the employer shall provide a clearly written notice to an injured employe of the employe’s rights and duties under section 306(f.1)(1)(i) of the act (77 P. S. § 531(1)(i)).
(b) The contents of the written notice shall, at a minimum, contain the following conditions:
(1) The employe has the duty to obtain treatment for work-related injuries and illnesses from one or more of the designated health care providers for 90 days from the date of the first visit to a designated provider.
(2) The employe has the right to have all reasonable medical supplies and treatment related to the injury paid for by the employer as long as treatment is obtained from a designated provider during the 90-day period.
(3) The employe has the right, during this 90-day period, to switch from one health care provider on the list to another provider on the list, and that all the treatment shall be paid for by the employer.
(4) The employe has the right to seek treatment from a referral provider if the employe is referred to him by a designated provider, and the employer shall pay for the treatment rendered by the referral provider.
(5) The employe has the right to seek emergency medical treatment from any provider, but that subsequent nonemergency treatment shall be by a designated provider for the remainder of the 90-day period.
(6) The employee has the right to seek treatment or medical consultation from a nondesignated provider during the 90-day period, but that these services shall be at the employee’s expense for the applicable 90 days.
(7) The employee has the right to seek treatment from any health care provider after the 90-day period has ended, and that treatment shall be paid for by the employer, if it is reasonable and necessary.
(8) The employee has the duty to notify the employer of treatment by a nondesignated provider within 5 days of the first visit to that provider. The employer may not be required to pay for treatment rendered by a nondesignated provider prior to receiving this notification. However, the employer shall pay for these services once notified, unless the treatment is found to be unreasonable by a URO, under Subchapter C (relating to medical treatment review).
(9) The employee has the right to seek an additional opinion from any health care provider of the employee’s choice when a designated provider prescribes invasive surgery for the employee. If the additional opinion differs from the opinion of the designated provider and the additional opinion provides a specific and detailed course of treatment, the employee shall determine which course of treatment to follow. If the employee opts to follow the course of treatment outlined by the additional opinion, the treatment shall be performed by one of the health care providers on the employer’s designated list for 90 days from the date of the first visit to the provider of the additional opinion.
(c) The written notice to an employee of the employee’s rights and duties under this section shall be provided at the time the employee is hired and immediately after the injury, or as soon thereafter as possible under the circumstances of the injury. If the employee’s injuries are so severe that emergency care is required, notice of the employee’s rights and duties shall be given as soon after the occurrence of the injury as is practicable.
(d) The employer’s duty under subsection (a) shall be evidenced by the employee’s written acknowledgment of having been informed of and having understood the notice of the employee’s rights and duties. Any failure of the employer to provide and evidence the notification relieves the employee from any duties specified in the notice, and the employer remains liable for all treatment rendered to the employee. However, an employee may not refuse to sign an acknowledgment to avoid duties specified in the notice.
Source The provisions of this § 127.755 amended January 16, 1998, effective January 17, 1998, 28 Pa.B. 329. Immediately preceding text appears at serial pages (203516) to (203517).
Notes of Decisions Acknowledgment of Notice
When read in conjunction with section 306(f.1) of the Workers’ Compensation Act (77 P. S. § 531(f.1)), § 127.755(d) (relating to required notice of employee rights and duties) requires that an employersecures written acknowledgment from the employee that he or she received written notice of the employee’s rights and duties both upon hiring and after occurrence of an injury. Department of Corrections v. Workers’ Compensation Appeal Board, 805 A.2d 633 (Pa. Cmwlth. 2002); appeal denied 813 A.2d 847 (Pa. 2002).
Notice Requirement
When read in conjunction with section 306(f.1)(1)(i) of the Workers’ Compensation Act (77 P. S. § 531(f.1)(1)(i)), § 127.755(c) (relating to required notice of employee rights and duties) requires an employer to provide written notice of the employee’s rights and duties on two occasions: first, upon hiring; and second, as soon as practicable after the employee suffers an injury. Department of Corrections v. Workers’ Compensation Appeal Board, 805 A.2d 633 (Pa. Cmwlth. 2002).
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