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Utah Compliance



Physician Selection R612-300-2

An employer may adopt managed health care programs and may designate specific health care providers as "preferred providers" for providing initial medical care for injured workers.

A preferred provider program must allow an injured worker to select from two or more providers to obtain necessary medical care.

An injured worker subject to a preferred provider program must seek initial medical care from a preferred provider unless:

a. No preferred provider is available;

b. The injured worker believes in good faith that his or her medical condition in not a workplace injury; or

c. Travel to a preferred provider is unduly burdensome.

If an injured worker who is subject to a preferred provider program fails to obtain initial medical care from a preferred provider, the employer's liability for the cost of the initial medical care is limited to the amount they would have paid a preferred provider. The injured worker may be held personally liable for the remaining balance.

After an injured worker has received initial care from a preferred provider, the employee may obtain subsequent medical care from a qualified provider of his or her choice.

An injured worker may change health care providers one time without obtaining permission from the payor. The following circumstances DO NOT constitute a change of health care provider:

a. A treating physician's referral of the injured worker to another health care provider for treatment or consultation;

b. Transfer of treatment from an emergency room to a private physician, unless the emergency room was designated as the payor's preferred provider;

c. Necessary emergency treatment;

d. A change of physician necessitated by the treating physician's failure or refusal to rate a permanent partial impairment.

The injured employee must promptly report any change of provider to the employer.

After an injured worker has exercised his or her one-time right to change health care providers, the worker must request approval of any subsequent change of provider. If the employer denies or fails to respond to the request, the injured worker may request approval from the Director of the Division on Industrial Accidents. The Director will authorize a change of provider if necessary for the adequate medical treatment of the injured worker or for other reasonable cause.

 

An injured worker who changes health care providers without employer or Division approval may be held personally liable for the non-approved provider's fees.

Application to Change Doctors