Article by Joseph Romano, Esq.
For Pennsylvania employers and insurers, workers’ compensation panel providers can be an important tool for managing medical care, supporting injured employees, and controlling claim costs. However, the value of a panel depends heavily on compliance. If the panel is not properly created, posted, and communicated to the employee, the employer may lose the ability to require treatment with panel providers during the first 90 days of care.
Panel care has become a hot topic amongst attorneys for injured workers as they seek ways to invalidate the panel and allow their clients to treat off panel immediately. Once an afterthought, injured workers are now regularly attacking whether the panel is valid and all requirements are met. Because of this, it is important to take a moment and familiarize yourself with the rights, rules, and responsibilities related to panel treatment.
Pennsylvania panel provider requirements are governed by the Workers’ Compensation Act and the Medical Cost Containment Regulations, including Section 306(f.1) and MCCR 127.752 through 127.755. In practice, compliance requires attention to both the statute and the regulations.
What Is a Panel Provider?
A panel provider is a medical provider designated by the employer to treat work-related injuries. If the employer is compliant with the panel rules, an injured worker is generally required to receive treatment from a listed panel provider for the first 90 days of treatment. If the employee chooses to treat outside the panel during that period, the employer may be able to deny payment for that treatment. Importantly, non-panel treatment is not automatically invalid, but payment responsibility may be affected.
The goals of panel treatment include supporting proper care for the injured worker, documenting the injury and treatment, helping with return-to-work planning, and controlling medical costs.
Core Panel Requirements
To maintain a valid panel, employers must satisfy several technical requirements. The employer must designate providers, provide written notice, and obtain a signed Notice of Employee’s Rights and Duties.
The panel must include at least six different providers, at least three physicians, no more than four coordinated care organizations, and geographically accessible options. Each provider listing should include the provider’s name, address, phone number, and specialty. The employer must also disclose any employment, ownership, or control relationship with a listed provider.
The panel must be posted in prominent, readily accessible locations at the worksite. Common locations include areas near the time clock, HR office, lunchroom, or other employee bulletin boards.
The Notice of Employee’s Rights and Duties is especially important. It must be signed at the time of hire and again after the injury. When possible, the post-injury notice should be signed immediately. If emergency care is required, it should be completed as soon as practicable after emergent care.
The 90-Day Rule and Common Exceptions
The 90-day treatment requirement only applies when the employer is compliant. After 90 days, the injured worker may receive treatment from a provider of their choosing.
There are also exceptions. These may include emergency care, situations where no appropriate specialty is available on the panel, referrals from a panel provider to a non-panel provider, and second opinions for invasive surgery. Employers and insurers should review these situations carefully before denying payment.
Reasons Why Panels Fail
Panel issues often arise for the following reasons: (1) because the Notice of Employee’s Rights and Duties was not completed after the injury, (2) the posted panel was outdated, or (3) the panel failed to include appropriate specialties.
Depending on the workforce and injuries, employers may need providers such as orthopedic surgeons, pain medicine specialists, physiatrists, chiropractors, physical therapists, occupational medicine providers, urgent care centers, neurologists, and pharmacies.
Employers should work with carriers annually to review panel compliance, provider availability, and specialties. HR, safety teams, and supervisors should also understand the process.
Get Guidance on Panel Provider Compliance
Burns White helps employers, insurance carriers, self-insured entities, and third-party administrators manage workers’ compensation claims . If you have questions about panel provider requirements, medical treatment issues, or return-to-work planning, our workers’ compensation attorneys are ready to help.