In the absence of designation of a managed health care system by the employer, the employee may select medical providers to treat his injury or occupational disease.
(KY Revised Statutes, 342.020(1))
Change of Provider
Following initial selection of a designated physician, the employee may change designated physicians once without authorization of the employer or its medical payment obligor. Referral by a designated physician to a specialist shall not constitute a change of designated physician unless the latter physician is specifically selected by the employee as the second designated physician. (803 KAR 25:096 Sec. 4)
Per discussions with KY DWC, the state advised that a non MCO employer may provide a list of physicians as recommendation only, provided the employee is aware s/he is not obligated to choose from the list. However, in the past, enforcement actions have been brought and fines issued where an employers' HR staff in actual practice tried to direct the medical care of injured employees. Therefore, care should be taken not to interfere with the injured employee's right to choose his/her own treating physician.
Employee Selects from Network
If the employer has entered into an authorized managed care program, the employee must choose from among the participating medical providers. (KY Revised Statutes, 342.020(4))
Change of Provider
Except for emergency medical care, medical services rendered pursuant to this chapter shall be under the supervision of a single treating physician or physicians' group having the authority to make referrals, as reasonably necessary, to appropriate facilities and specialists. Employee may change his designated physician one (1) time and thereafter must show reasonable cause in order to change physicians. (KY Revised Statutes, 342.020(5))
In previous discussions with KY regulators, the State has advised that an MCO may provide a panel of all gatekeepers in an enrollee's geographical area along with a directory website address to satisfy MCO requirements. The providers must be listed by county and list all gatekeepers in a county or surrounding counties. The panel and website address replaces the requirement for an entire directory.
The information on this website constitutes summary information only and does not constitute legal advice. Review of the full text of the referenced statutes and regulations may be necessary. Coventry Health Care Workers' Compensation, Inc. makes no representations or warranties about the accuracy of the information contained on this website.