Provider Panel Considerations

What is a panel?

A valid panel is a list of at least three different providers from at least three different practice groups from which the claimant may select an authorized treating provider.

Once a provider is selected from a panel, the claimant is limited to treating with that provider and with the referrals made by that provider.

Why is a panel important?

The panel is an important tool, as it provides some control to the employer and carrier in limiting which doctors the claimant may treat with in the workers’ compensation claim. After the treating physician is established in a claim, it can be difficult for either party to later change treating physicians unless all parties agree.

The Commission generally gives great weight to the opinion of the treating physician, so starting off with a good doctor can be very important over the life of a claim. Additionally, if the claimant seeks treatment outside of the panel selection or the direct line of referral, then that treatment can be denied as unauthorized.

Best Practices for Offering a Panel

  1. Offer the panel in writing. Ask the claimant to select a provider in writing. Posting the panel as a notice or providing it during safety meetings is not sufficient.
  2. Include the names of at least three providers from at least three different practices. The name of the provider at the practice must be included. Referring the claimant to a clinic without listing a provider is not sufficient. A director of an urgent care facility can be listed to meet this requirement.
  3. Include physicians of the specialty needed. For example, if the claimant needs orthopedic treatment, do not include a family doctor on the panel. Further, if the claimant needs treatment for their back, do not include hand specialists on the panel.
  4. Offer the panel as soon as possible after the employer or carrier becomes aware of the need for medical treatment. There is no specific rule on how long the employer or carrier has to offer a panel. It must be provided within a reasonable time. It is generally best to offer it as soon as possible, ideally within seven days of when the employer or carrier knows it is needed to avoid any claim that the panel is untimely or that the claimant has already established treatment with a provider of their choice.
  5. The panel providers should be within a reasonable distance from the claimant’s home. What is reasonable depends on many factors, such as where the claimant lives, the availability of providers of the appropriate specialty in the area, and the claimant’s limitations. Generally, providers within a 50-mile range of the claimant may be within a reasonable distance.
  6. The provider must be willing to see the claimant. If the panel contains a provider who is not willing to provide treatment, the panel may be considered defective.

What if No Panel if Offered?

Generally, there is no penalty for not offering a panel. However, if you do not offer a panel, the claimant is free to choose their own physician. The doctor that the claimant begins seeing will become the treating physician if the employer or carrier fail or refuse to provide a panel.

For any of the scenarios below, one solution is to contact either the claimant (or the claimant’s attorney, if the claimant is represented), to discuss the problem and to see if a mutually-agreeable solution can be reached.

Common Panel Problems

Attorneys are familiar with some of the common challenges listed below and are often willing to compromise on panel requirements to facilitate authorized treatment.

If the parties can agree to an exception to traditional panel requirements, it is recommended that the agreement be documented in writing (for example, in an email to the attorney, or in the panel letter)

1.     The claimant needs an orthopedist, but there is only one provider group in the immediate area.

  • In a situation like this, it may be appropriate to include providers who are farther away to complete the panel. A willingness to provide or reimburse transportation if a farther provider is selected will strengthen the argument that it is still a valid panel despite the distance.

  • Consider listing multiple orthopedists from the local group in addition to orthopedists at two different practices located farther away.

2.     The claimant needs a psychiatrist, but there are not enough providers taking new patients or who accept workers’ compensation to fill a panel.

  • Look to the need that is being addressed. Is the purpose of the treatment to provide medication? One solution, with the agreement of the claimant or claimant’s attorney, would be to authorize a one-time assessment with a psychiatrist to establish a treatment plan, with an agreement that medications and treatment can thereafter be managed by a physician assistant or nurse practitioner.

  • Is counseling the purpose of the referral? Other providers may be appropriate in lieu of a psychiatrist, such as licensed clinical social workers, psychologists, licensed professional counselors – the referring physician can often provide clarification on this to expand the types of providers who can be used to create a valid panel.

  • Look at non-traditional treatment settings to expand the list of potential providers, such as telemedicine.

3.     Claimant did not timely report the accident.

  • Offer a panel as soon as the accident is reported; whether this will be considered timely will be a fact-specific determination, but this will place the employer/carrier in the strongest position for the argument.

  • If the claimant selects from the panel, even if it is offered long after the accident, this may still be considered a valid panel selection.

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