VWCC EDI Upates

The Virginia Workers’ Compensation Commission has updated several documents related to its EDI program. To view these changes, visit the VWCC website where you will find the Commission's Final Implementation Guide and IG Post Publication Change Log.

Physician Panels - To Provide or Not to Provide - That is the Question

After receiving notice of an accident or occupational disease from an employee, employers are required to provide the employee with a panel of physicians from which to select a treating physician.  If the employer does not provide a panel, the employee may elect to receive treatment from any healthcare provider he or she chooses.   

What constitutes a “proper panel” of physicians?  The Virginia Workers’ Compensation Commission uses a “reasonable” standard in determining the validity of a physician panel.  “Reasonable” depends on many factors, such as the nature and severity of the injury and availability of physicians in a given area, and often include the following.   

1. The panel must be provided within a reasonable time after being notified of the injury. 
2. The panel must consist of at three (3) physicians, who are not affiliated with each other.
3. Physicians must be listed by name. Merely listing clinics may not be sufficient.
4. A panel is not valid if a physician is unwilling to see new patients or to treat workers’ compensation patients. 
5. The distance from the injured workers’ residence to the panel physician must be reasonable; a panel may be invalid if a physician is 50 miles or more away from the injured workers’ residence. 
6. The panelmust be provided directly to the injured worker following notice of the injury or claim. 
7. Posting a notice or advising employees of a “stock” panel is not a sufficient means of providing an injured worker with an appropriate panel.  

What is the result of a defective panel?  The Virginia Workers’ Compensation Commission has determined that the injured worker may select his own physician when presented with a defective panel.  The employer, or its insurance carrier, then becomes liable for all care provided by that chosen physician, as well as any referrals for treatment causally related to the work injury.  

This is important because, although employers and carrier cannot medically manage a workers’ compensation claim, it is often the job of the insurance adjuster or designated employer representative to maintain contact with medical care providers in an effort to return the injured worker to work.  Facilitating the progression of a workers’ compensation claim by ensuring that a case is medically managed appropriately can save the employer enormous amounts of time and money.  Keeping the lines of communication with health care providers open is therefore imperative, and often easier to accomplish if the treating physician is one that was selected by the employer or carrier.  

Accordingly, when a worker is injured or otherwise files a claim for an injury at work, immediately provide medical care as appropriate, whether that consists of emergency treatment or offering an appropriate physician panel.  This is a solid practice to follow, even if the claim is going to be denied.