On Workers' Comp in Pennsylvania but Getting No Medical Treatment

Attorney Answer

Medical treatment is part of what workers' comp provides, not an extra. Pennsylvania's act requires the employer to pay for reasonable medical care as and when needed. The practical question is why you are not being treated: no appointment made, no provider you are allowed to see, or a refusal. Each has a different fix.

The employer pays for treatment. Section 306(f.1)(1)(i) of the Workers' Compensation Act requires the employer to pay for reasonable surgical and medical services, medicines and supplies, as and when needed.

Which doctors, and for how long. The same section lets an employer post a list of at least six designated health care providers. If it did, you treat with a provider on that list for 90 days from your first visit. If invasive surgery is prescribed, you may get an additional opinion from a provider of your own choice. If no list was posted, that 90-day requirement does not arise.

You should not be billed. Under Section 306(f.1)(7), a provider may not hold an employee liable for the cost of care for a compensable injury, and may not bill the employee for the difference between its charge and what the insurer paid.

If the insurer is refusing treatment, the dispute goes before a workers' compensation judge. That is a legal proceeding, and it is where a workers' compensation lawyer earns their fee.

What you can do

1. Ask your employer for its posted list of designated providers, or confirm in writing that there is none.

2. Book an appointment with a listed provider, or with your own doctor if there is no list or the 90 days have passed.

3. Give every provider your workers' compensation claim number and the insurer's name.

4. Keep any letter that refuses or delays treatment.

5. If treatment is being refused, speak with a Pennsylvania workers' compensation lawyer. Most offer a free first consultation.

⏱ Time limits apply. If your employer posted a provider list, the 90-day period under Section 306(f.1)(1)(i) runs from your first visit. Don't let weeks pass without treatment; gaps in care are often used to argue an injury has resolved.