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For injuries on or after July 1, 2014 50-6-204
Upon the report of a workplace injury, an employer should provide the employee, the C-42 Agreement Between Employer / Employee Choice Of Physician
If the date of injury is on or after July 1, 2014, the form should include:
Effective until 7/1/14 50-6-204
If the date of injury is prior to July 1, 2014, the form should include:
The employee has the right to choose a physician from the list. The physician selected by the employee becomes the “authorized treating physician”. The employee is required to accept treatment from the authorized treating physician and should not seek treatment from any other medical provider unless the authorized treating physician makes a referral. The C-42 form must indicate the name of the physician chosen by the injured employee, be signed by the employee with a copy given to the employee, and the original kept on file with the employer. Employees may also be asked to sign a C-31 Medical Waiver and Consent Form. to allow the employer and/or insurance adjuster to receive copies of medical notes and reports from the chosen physician.