Create A Panel of Physicians
Don’t lose out on your one opportunity to influence the quality and cost of care provided to your injured employees! In Virginia, you, as the employer, have the right and OPPORTUNITY to present an injured employee with a list of physicians to choose from if medical care is required. And it is a “one-shot” opportunity because, if the employer does not have a list or “panel” of physicians, then the employee can essentially seek medical treatment wherever they choose.
CLICK THE LINK below to create a Panel of Physicians for your dealership!
IMPORTANT INFORMATION ABOUT BUILDING A PANEL
In Virginia, you, as the employer, have the right and OPPORTUNITY to present an injured employee with a list of physicians to choose from if medical care is required. And it is a “one-shot” opportunity because, if the employer does not have a list or “panel” of physicians, then the employee can essentially seek medical treatment wherever they choose.
While there is no requirement that an employer have a panel, it is highly recommended. The Panel of Physicians is the only opportunity you have to inject any influence on the claim. Once the treating relationship is established between an employee and the physician, the physician is in full control over what happens. Therefore, it is of great benefit to the employer to make certain the physician is going to provide good communication, be focused on getting the employee back to work, and provide good quality medical care for the injured employee to prevent re-injury — hopefully at predetermined contracted rates (i.e. in the VADA GSIA/PMA medical network for billing).
There are rules and parameters surrounding what make a valid panel that can be enforced. The basics are:
- There must be at least three practicing physicians (preferably four or five) who are not affiliated with each other for the employee to choose from.
- Physicians must be listed by name; Company names are not sufficient.
- The distance from the injured employee’s home to the panel physician’s office must be reasonable.
- The panel must be provided directly to the employee following notice of the injury or claim; an employee may be sent to an urgent care facility or emergency room, but they should be provided with the panel in the event additional care is necessary.
- For non-emergency treatment, listing the physicians from three local occupational clinics or urgent care facilities is a good way to start. Should a referral to a specialist be made, you can direct the employee to PMA who can assist with a panel of specialists.
- The Panel must be updated regularly. An injured employee can choose his own physician when presented with an invalid panel. That chosen physician then drives all care provided, including any referrals for treatment causally related to the work injury.
A panel is not valid if:
- A physician is unwilling to see new patients or to treat workers’ compensation patients.
- The distance from the injured employee’s home to the panel physician is unreasonable (generally 50 miles or more away from the injured workers’ residence, though this may vary significantly depending upon the area of the Commonwealth).
- The panel was not provided directly to the injured employee following notice of the injury or claim (just posting a notice or advising employees of the existence of a panel is not an acceptable means of providing an injured worker with a valid panel, though we certainly encourage the posting of the panel).
Having a valid Panel is great, but you must also be able to prove that the employee was aware that the panel existed and that they must utilize it if they are injured. This can be accomplished at both the orientation time, via posting it in the workplace, and by re-presenting it at the time the injury is reported by the employee.
If the above criterion is met, then the employee MUST select from the list. If they then CHOOSE to seek treatment elsewhere, the employer/workers comp insurance carrier is not obligated to pay for the treatment.
Of course if the injury requires emergency medical treatment there are no initial restrictions. But if follow-up care were needed, the panel can and should be enforced.
In lost time cases, where longer term medical care is sought, our adjusters and nurse case managers review whether a panel was offered and intervene by via presenting a panel to the injured employee on the employer’s behalf if we receive the claim soon enough. In more remote areas, or areas that are big enough to have facilities and specialists, but not big enough to have very many of them, the providers have little incentive to sign-up with ANY medical network. In these cases, it is in the employer’s best interest to seek out a few good medical options and get them involved: invite them to the dealership to see the operations, require them to be willing to address modified duty while an employee heals, etc.
Creating a Panel is quick and easy with tools provided by VADA GSIA and PMA. If you don’t currently have a Panel of Physicians in place, please contact Michael Allen, VADA GSIA General Manager at 804.545.3012 or firstname.lastname@example.org.