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
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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