Do Laws Directing Injured Workers to Providers Matter?
The laws regarding workers’ comp are continually evolving.
The recently-published analysis of employer directions to injured workers on the WCRI website is misleading on the recent law.
The headline forces one to assume there is no difference in the costs for an employee or employer choosing the physician. Sadly, this conclusion is wrong.
If you further dip into the study, you notice that these injuries were gathered from 2007 to 2010 and spanned 25 states. These states allowed the employee or employer discretion with his or her choice of providers. States where workers can only select a provider in the employer’s network are excluded from the research.
What the Research is Not Telling You
WCRI used particular wording that created ambiguity regarding the law.
The employer-choice for referring injured workers to providers and the employee-choice is no clear cut line. Instead, these two areas mesh together in a muddled gray area.
The research from WCRI is fascinating, but it forgets the fact that employees have the right to opt out of the course of treatment from one physician and choose another. Furthermore, employers cannot force an employee to visit a doctor or choose a physician from a panel in individual states.
How Does It Apply in Virginia?
In Virginia, the research does not apply.
An employer must provide employees with a panel of physicians to choose from per Virginia Code Section 65.2-603. The physician is selected immediately after reporting the work-related injury or illness.
A panel must consist of three physicians’ at minimum. A defective panel is any panel with fewer than three doctors or only names of medical facilities.
Employee Does Not Choose Providers for the Panel
In Virginia, the group comes from the employer and their workers’ compensation insurance carrier. Referrals for injured workers to providers originate from the board directly. The attorney for the injured worker nor the worker can choose any physician that isn’t on the list.
Why Do These Laws Matter for Workers Comp?
The laws matter because an injured worker must follow protocol to receive payment for their medical treatments.
Sadly, workers have no right to choose any physician in Virginia. Furthermore, payment for all necessary treatments run through the panel and the workers’ compensation insurer.
If the employee were to refuse medical services by a provider, then the employee is barred from further compensation.
How the Report Ties In
In the report, it states that there is little evidence of cost differential between employer-selected and employee-selected providers. However, with this report ignoring the states where employees only select from a panel, it leaves out the obvious cost masking by insurers allowing a group of low-cost providers to care for injured workers in the state.
Taking Guidance from a Workers’ Comp Specialist is Best
With the conflicting information out there and the strict laws of the Virginia Workers’ Compensation system, it is best to work with a consultant. A consultant can ensure timely payments between all parties, and help decode the complicated network of laws that protect Virginia workers and employers alike.