Employee Selects from Network
A preferred provider program may be developed if the preferred provider program allows a selection by the employee of more than one physician in the health care specialty required for treating the specific problem of an industrial patient. If a preferred provider program is developed by an insurance carrier or self-insured employer, an employee is required to use: preferred provider physicians; and preferred health care facilities. If a preferred provider program is not developed, an employee may have free choice of health care providers. (Utah Code Ann. § 34A-2-111)
Change of Provider
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 treating physician's referral of the injured worker to another health care provider for treatment or consultation; transfer of treatment from an emergency room to a private physician, unless the emergency room was designated as the payor's preferred provider; necessary emergency treatment; a change of physician necessitated by the treating physician's failure or refusal to rate a permanent partial impairment. The injured employee shall promptly report any change of provider to the payor. (U.R.C. R612-300-2)
See Direction of Care law.
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.