The answer depends. It depends upon whether the employer has a preferred plan organization (PPO) or a medical care plan or some similar type of plan that is filed with the Chairman’s Office in Hartford. If this is a specific plan which has been properly filed, such plan allows the employer to negotiate with a particular group of doctors and to require the injured employee to treat within that group. This information can be ascertained by calling the Chairman’s Office in Hartford and providing the name of employer and the date of injury. It may take a day or so for the office to get back to you, but they will let you know whether there is such a plan, in which case the injured employee is obligated to treat with one of the doctors specified in the plan.
Should the employee treat outside of that plan, the employer may suspend all of the employee’s workers’ compensation benefits, including any temporary total or temporary partial. Further, the employer is not obligated to pay for any such medical bills since the medical providers are outside of its plan.
If the carrier fails to issue a Voluntary Agreement within 28 days of filing the Form 30C, or if the respondent denies the claim, then the injured employee may treat wherever she wishes. If, subsequently, the respondent accepts the case, a good argument can be made that the claimant should be able to continue treating with the original, out-of-network, treater since the claimant has developed a relationship with the physician and it would be unfair to wrest her away from the original treater at this later date.
Another situation which frequently arises is where a treater within the PPO or managed care plan refers the claimant to a specialist outside of the PPO. Very often the claimant is unaware of the existence of the managed care plan, and the claimant should not be punished if she treats with the out-of-network new physician that was referred to her by the treating physician, if that treater is not within the managed care plan.
There are particular requirements each plan must meet concerning the number of physicians not associated within the same medical group offered in each specialty area, as well as how the existence of the plan must be made known to each employee prior to the date of injury for such plan to be valid.