The employer must notify the employee of their right to select a physician who has maintained the employee's medical records and has a documented history of treatment with the employee prior to the injury. If the employee fails to make this selection, the employer has the right to select the physician. If the employer fails to notify the employee of such right of selection, the employee has the right to select a physician. (R.R.S. Neb § 48-120)
Change of Provider
The employee or employer shall not change the initial selection of physician unless such change is agreed to by the employee and employer or is ordered by the Compensation Court. (R.R.S. Neb § 48-120)
See Direction of Care law.
Employee Selects from Network
Employees must receive initial evaluation by a participating licensed physician in one of the disciplines listed below in Rule 53,E,3 within 24 hours of the employee's request to the managed care plan for treatment following an injury. The managed care plan may select the physician to do the evaluation. (NE WC Court Rules of Procedure Rule 53(E)(1))
Following the initial evaluation and upon request, the employee must be allowed to choose to receive ongoing treatment from any one participating physician in one of the disciplines listed below as the primary treating physician, if the physician is available within the mileage limitations established, if the treatment is required under the NE Workers' Compensation Act, if the treatment is within the provider's scope of practice, and if the treatment is appropriate under the standards of treatment adopted by the managed care plan: Medical doctor, chiropractor, podiatrist, osteopath, and dentist. (NE WC Court Rules of Procedure Rule 53, (E)(3))
Employees must have access to the evaluating and primary treating physician within 30 miles of either the employee's place of employment or residence if either the residence or place of employment is within a city with a population of 5,000 or more. If both the employee's residence and place of employment are outside a city with a population of 5,000 or more, the allowable distance is 60 miles, (NE WC Rules of Procedure Rule 53,(E)(7))
The compensation court shall certify an MCP if the compensation court finds that the plan: (h) Authorizes employees to receive medical, surgical, and hospital services from a physician who is not a member of the MCP if such physician has been selected by the employee pursuant to subsection (2) of section 48-120 (the employee has pre-designated a physician that has maintained the employee's medical records prior to an injury, has a documented history of treatment with the employee prior to an injury) and if such physician agrees to refer the employee to the MCP for any other treatment. (R.R.S. Neb. § 48-120.02)
Change of Provider
Employees must be allowed to change primary treating physicians within the MCP at least once by making application for such change to the plan without proceeding through the managed care plan's dispute resolution process. A change of physician from the evaluating physician to a primary treating physician for ongoing treatment is not considered a change of physician, unless the employee has received treatment from the evaluating physician more than once for the injury (NE WC Court Rules of Procedure Rule 53(E)(5))
See Direction of Care law for network access requirements.
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.