(2)Any time after acceptance of liability by an insurer, the insurer may designate or approve a treating physician who agrees to assume the responsibilities of the treating physician. The designated or approved treating physician:
(a) is responsible for coordinating the worker's receipt of medical services as provided in 39-71-704;
(b) shall provide timely determinations required under this chapter, including but not limited to maximum medical healing, physical restrictions, return to work, and approval of job analyses, and shall provide documentation; (c) shall provide or arrange for treatment within the utilization and treatment guidelines or obtain prior approval for other treatment; and (d) shall conduct or arrange for timely impairment ratings.
(3) The treating physician may refer the worker to other health care providers for medical services, as provided in 39-71-704, for the treatment of a worker's compensable injury or occupational disease. A health care provider to whom the worker is referred by the designated treating physician is not responsible for coordinating care or providing determinations as required of the treating physician. (Mont. Code Anno., § 39-71-1101)
(3) Any time after an insurer accepts liability for an injury or occupational disease, the insurer may recognize a treating physician selected by the injured worker. The treating physician is compensated at 100 percent of the fee schedule.
(4) After acceptance of liability, the insurer may formally approve the treating physician selected by the injured worker as a designated treating physician or may choose a difference physician to be the designated treating physician. The designated treating physician is compensated at 110 percent of the fee schedule.
(a) The designated treating physician is responsible for coordination of medical care, pursuant to 39-71-1101(2), MCA. The designated treating physician must agree to accept these responsibilities.
(b) The insurer must provide formal notification of the designated treating physician by e-mail, facsimile, or letter to:
(i) the injured worker;
(ii) the current treating physician; and
(iii) the designated treating physician. The effective date of the designation of treating physician is the date the insurer sends the notice of designation unless the physician declines within ten working days. (Mont Admin. R. 24.29.1512)
Injured workers who need emergency care should always be taken to the nearest medical facility for immediate care. However, if the injury is not an emergency and you need to locate a qualified physician in the area call Montana State Fund at 800-332-6102.
You choose. You are allowed to choose your initial treating physician. This is the medical provider primarily responsible for treating your injury or occupational disease. However, by law, you do not have complete freedom of choice in medical providers. (Choosing A Medical Provider/Preferred Provider) https://www.montanastatefund.com/web/worker/choosingaprovider.jsf
(8)The insurer may direct the worker to a MCO or PPO for designation of the treating physician.
(9)After the insurer directs a worker to a MCO or PPO, a health care provider who otherwise qualifies as a treating physician but who is not a member of a MCO may not provide treatment unless authorized by the insurer.
(10)After the date that a worker whose injury is subject to the provisions of subsection (9) receives individual written notice of a referral, the worker must, unless otherwise authorized by the insurer, receive medical services from the organization designated by the insurer, in accordance with 39-71-1102 and 39-71-1104. The designated treating physician in the organization then becomes the worker's treating physician. The insurer is not liable for medical services obtained otherwise, except that a worker may receive immediate emergency medical treatment for a compensable injury from a health care provider who is not a member of a MCO or a PPO. (Mont. Code Anno., § 39-71-1101)
(11)Posting of managed care requirements in the workplace on bulletin boards, in personnel policies, in company manuals, or by other general or broadcast means does not constitute individual written notice. To constitute individual written notice under this section, information regarding referral to a managed care organization must be provided to the worker in written form by mail or in person after the date of injury or occupational disease. (Mont. Code Anno., § 39-71-1101)
In previous discussions with MT regulators, the State has advised that the notice given the injured worker that they can choose their initial treating physician, needs to be posted along with the list of MCO doctors. The injured worker cannot be required to chose an initial treating physician from the MCO list. The worker may select whomever they chose as their initial treating physician (within the definition of a "treating physician").
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.