Medical Care

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Injured workers have the right to make the initial choice of their doctor. Treatment at an emergency room or with a doctor under contract with the employer does not count as the initial choice of a doctor.

After having made such a choice, injured workers also have the right to be referred to a doctor of their choice who is a specialist for their type of injury. Afterwards, if an injured worker wants to switch to a different doctor, then he/she may only see a doctor who is included on a list maintained by the insurance company, called a Preferred Provider Network (PPN), or get approval from the insurance company to see a doctor who is not on the PPN. If the employer has no PPN, then the injured worker may switch to any doctor whom he/she chooses.

Read full text of statute » 28-33-8.

In general, an insurance company is required to pay for all medical services and expenses that are necessary to cure, rehabilitate, or relieve an injured worker from the effects of a work related injury. There are protocols of treatment that vary depending on the nature of the diagnosis which may limit the type of treatment that an injured worker may receive at a particular point in time. Also, there are some limits on medical treatment that an injured worker may receive after being found to be at maximum medical improvement.

Read full text of statute » 28-33-5 and 28-33-10

Although an insurance company is required to pay for medical services, they are not required to give permission for any type of testing or treatment. Permission for medical services is only necessary for major surgery. If an insurance company refuses to grant permission for major surgery or any other type of treatment or testing, then permission may be obtained by the injured worker from the Workers’ Compensation Court.

 

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