USCC Workers Comp 2024 - 89

Chart IX-Waiting Period for Income/Medical Benefits, cont.
Notes
If disability continues for longer than stated
retroactive periods, compensation is paid for the waiting
period. Waiting periods do not apply to medical care,
which is furnished from first day of injury.
2.
1.
Many states have introduced medical fee schedules
to control payments made to providers for medical
care under workers' compensation programs. Medical
benefits remain " unlimited " in states indicated, but
employers and insurers are only liable for amounts set
forth in medical fee schedule. Employees cannot be held
accountable for any amount charged above and beyond
medical fee schedule.
3.
Alabama-Temporary disability only.
Alabama-Employee may select a second physician
from a panel of four selected by employer if employee
is dissatisfied with initial treating physician and further
treatment is required.
5.
4.
one IME per accident and not one IME per medical
specialty. The party requesting and selecting an IME
shall be responsible for all expenses associated with
said examination.
14.
Nevada-Waiting and retroactive period is at least five
consecutive or cumulative days within a 20-day period.
35.
34.
Georgia-Included in total amount allowed for
medical care. The waiting period applies to income
benefits only-injured workers are entitled to medical
immediately following work injury. Unlimited for date of
injuries (DOIs) before 6/30/13. For DOIs after 7/1/13, 400week
limitation, except for catastrophic injuries and for
repair or replacement of prosthetic devices, spinal cord
stimulators, and certain durable medical equipment.
15.
17. Iowa-No waiting period for PP disability.
18. Kansas-Waiting period retroactive after three
Alaska-Care consisting of continuing and multiple
treatments of a similar nature subject to frequency
standard. After any condition becomes medically stable,
employer not liable for palliative care unless necessary
for continuing in employment at time of treatment,
participating in a reemployment plan, or relieving chronic
debilitating pain.
6.
Arizona-Employee has freedom of choice after one
visit as directed by employer. Self-insured employers
may elect to direct all medical.
7.
Waiting period does not apply to medical benefits.
Arkansas-May cease six months after injury when
no time from work is lost, six months after claimant
returns to work, or maximum $10,000 has been paid
unless employer may waive rights and commission may
extend limits.
9.
8.
weeks.
19.
Kansas-Employee may consult a physician of his
or her own choice at any time, but employer is only
liable for fees and charges up to $500 for treatment. This
unauthorized medical treatment cannot be used to obtain
functional impairment ratings.
20.
Kansas-Director must adopt rules, which establish
a maximum medical fee schedule subject to approval of
an advisory panel. Fee schedule to be revised every two
years.
21.
Nevada-If employer's insurer has selected a
managed care organization (MCO), employee is required to
choose a treating physician or chiropractor from MCO list.
36.
Idaho-Waiting period terminated by hospitalization.
16. Illinois-TT only.
Nevada-If employer's insurer does not have
contract with an MCO or provider of health care,
employee may select a physician or chiropractor
from a panel established by the Division of Industrial
Relations. If employer's insurer has a contract with an
MCO or provider of health care services, employee must
choose his or her treating physician pursuant to terms of
contract. If dissatisfied, employee may change selection
within 90 days to another physician or chiropractor from
the panel or contract group.
37.
New Hampshire-Unlimited for those not under a
managed care program.
38.
New Jersey-Employer responsible for all necessary
and reasonable costs of medical care, including
chiropractor authorized and selected by employer.
Employee has no freedom of choice.
39.
Oregon-Costs subject to medical fee schedules
adopted through rulemaking. Treatment may be restricted
to managed care organization plan providers.
40.
Kentucky-The waiting period is only for income
benefits. There is no waiting period for medical benefits.
22.
California-Psychologists and acupuncturists
included within definition of physician and treatment
permitted. Personal chiropractor allowed if employee
previously notified employer that chiropractic treatments
were being rendered. Regarding choice of physician,
California currently gives employer control of medical
care for life of claim when an employer has an approved
medical provider network (MPN). Otherwise, old law
allows that employer controls medical care for first 30
days after injury, and then control switches to injured
worker. AB 2068, Laws of 2006, chapter 819, provides
for a continuation of employee rights to predesignate a
personal physician for treatment of an industrial injury
and to broaden the definition of personal physician to
include a medical group, corporation, partnership, or
association of licensed physicians. It also deletes the
4/30/07 repeal date on predesignation of a physician
and removes the limit on the maximum percentage
of employees who may predesignate their personal
physician for workers' compensation medical treatment.
10.
California-Waiting period also terminated by
hospitalization.
11.
Connecticut-By court decision, Olmstead v.
Lamphier, 93 Conn. 20, 104 A. 488 (1918).
12.
Delaware-No waiting period for medical treatment
or period if incapacity results in hospitalization or is
caused by amputation of body member.
13.
Kentucky- " Gatekeeper " physician may be required
to file a treatment plan; not necessary in every case. In
addition, bills subjected to medical bill audit and may be
required to go through utilization review.
23.
24.
Maine-Firefighters are exempt from waiting period
and receive compensation from date of disability.
26.
25.
Maine-Employee may not change health care
provider more than once without employer or board
approval. This does not apply if referred to specialist.
27.
Michigan-Employer may choose physician for first
28 days of treatment; thereafter, employee may choose
his or her own physician by giving notice to employer.
28.
Louisiana-Choice of examining physician.
Louisiana-Choice of treating physician.
Oregon-Employees may choose physician or
authorized nurse practitioner within state (or outside
state, if insurer approves). Allowed initial choice
plus two changes by choice; insurer may object to
additional changes and require director's approval.
Oregon-certified chiropractors, naturopaths, and
physician assistants allowed to treat for 60 days or
18 visits, whichever occurs first, on initial claim, and
may authorize payment of temporary disability for 30
days. Oregon-authorized nurse practitioners allowed
to treat and authorize payment of temporary disability
for 180 days from initial visit on initial claim. If governed
by managed care organization, treatment and choice
of physician may be specified by the managed care
organization contract.
41.
Minnesota-If employer has a managed care plan,
employee must choose among the physicians within the
plan with certain exceptions.
29.
Missouri-Employer retains right to choose
physician. Medical fee dispute procedure established,
but Missouri has no medical fee schedule. All medical
fees must be " fair and reasonable. Employee retains right
to choose physician at own expense. "
30.
Montana-Waiting period refers to number of days
(hours) on which a worker has lost wages and is totally
disabled and unable to work.
31.
Nebraska-The first day of disability is included in
seven-day waiting period; a partial day of disability is
considered a full calendar day for purposes of waiting
period.
32.
Florida-After injured worker reaches MMI,
employee is responsible for $10 copayment for each
medical visit. Chiropractic services may be limited. If the
employer fails to timely provide the employee's specific
request for initial treatment or care, the employee
may obtain such initial treatment at the expense of the
employer. If the carrier fails to provide the employee's
one-time change of doctor within five days of the written
request of the employee, the employee may elect the
physician. Physician must prescribe professional or
nonprofessional attendant care and/or custodial care,
in writing, and shall not prescribe such retroactively.
The employer and employee shall be entitled to only
Pennsylvania-Employer may designate and post
a list of at least six designated health care providers.
At least three of the providers must be physicians; no
more than four of the providers may be coordinated care
organizations or combinations thereof. If employer posts
a list and accepts the claim, employee is required to
treat with a physician on the list. Employee may choose
any provider on the list, and employer cannot direct
employee to a specific provider. Employee must then
treat with that provider for 90 days after the initial visit.
After 90 days, or if employer does not accept the claim
or post a list, or if the list is improper, the employee can
treat with any provider he or she chooses.
42.
Rhode Island-Fee schedule updated as necessary,
not annually.
43.
Rhode Island-If employer has a preferred provider
network (PPN) in place, employee has choice of initial
physician, but subsequent choices must be made from
PPN or with permission of employer if outside PPN.
44.
Nebraska-Only if employee is informed of right to
choose treating physician and does not have a physician
with a record of previous treatment of employee or family
member.
33.
Nebraska-Only if employee has a treating physician
with a record of previous treatment with employee or
family member. If employer does not inform employee
of right to choose, employee may choose any doctor.
If employer has informed employee of right to choose,
employee cannot change treating physician unless
employer agrees or court orders change. Employee may
choose doctor for major surgery or if injury involves
dismemberment.
2024 Analysis of Workers' Compensation Laws | 89
South Dakota-Consecutive days, temporary
disability only.
45.
Tennessee-Medical payments subject to medical
fee schedule effective 7/1/05 and applies to medical
payments provided on or after 7/1/05.
46.
Texas-In-network: Medical charges subject to
network contract. Non-network: Medical charges
subject to division's medical fee guidelines.
47.
Texas-In-network: Employee chooses treating
doctor from list of network doctors and is allowed one
change without network approval. Subsequent changes
must be approved by the network. Non-network:
Employee chooses treating doctor and may request to
change treating doctors with division approval.
USCC Workers Comp 2024

Table of Contents for the Digital Edition of USCC Workers Comp 2024
