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Colorado Compliance

Physician Selection 8-43-404(5)(a)(1)(A)

In Colorado, the employer or insurance company has the right in the first instance to select the physician who attends an injured employee. This becomes the designated medical provider.

When selecting the designated physician it is extremely important to assure that you are furnishing the best medical care possible. Quality and appropriate medical care is important in cost containment and minimizing the effects of an injury to an employee. Be sure to check with your insurance company. They may have established preferred provider networks that can save additional medical expense.

The statute requires with some exceptions, that a list of at least four physicians, corporate medical providers, or a combination of both, where available, be provided by the employer so as to afford the injured employee the opportunity to select a treating physician. At least one of the designated providers must be at a distinct location from the other three and have distinct ownership. (Prior to 4/1/2015 only 2 physicians were required to be on the list)

If no physician is properly designated, the employee may attend the health care provider of his or her choice.

Initial Referral

When an employer has notice of an on the job injury, the employer or insurer must provide the injured worker with a written designated provider list, from which the injured worker may select a physician or corporate medical provider.

1) The designated provider list can initially be provided to the injured worker verbally or through an effective pre-injury designation. If provided verbally or through a pre-injury designation, a written designated provider list must be mailed, hand-delivered or furnished to the injured worker within seven (7) business days following the date the employer has notice of the injury.

2) The designated provider list must state the insurer responsible for the claim, or that the employer is self-insured. In addition, the designated provider list must include the name and contact information of the person, or a maximum of two people, that the employer and/or insurer designate as their representative(s).

If the employer fails to comply, the injured worker may select an authorized treating physician of the worker's choosing.

If an employer has a qualified on-site health care facility, the employer may designate that facility as the authorized treating physician.

One Time Change of Physician

Within 90 days following the date of injury, but before reaching maximum medical improvement, an injured worker may request a one-time change of authorized treating physician. The new physician must be a physician on the designated provider list or provide medical services for a designated corporate medical provider on the list. The medical provider(s) to whom the injured worker may change is determined by the designated provider list given to the injured worker

The injured worker must complete and sign the form established by the division for this purpose, form WC03 - Notice of One-Time Change of Physician.

The insurer must file any objection to the request in writing on a form prescribed by the director within 20 days of the certificate of service of the request form.

If permission is neither granted or refused within 20 days, the insurer is deemed to have waived any objection to the request.