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(In
effect as of January 1, 2004*) |
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TABLE 5a. MEDICAL BENEFITS PROVIDED BY WORKERS'
COMPENSATION STATUTES |
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Full Medical Benefits** |
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| Alabama |
Indiana |
Nebraska |
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South Carolina |
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| Alaska |
Iowa |
Nevada |
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South Dakota |
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| Arizona |
Kansas |
New Hampshire |
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Tennessee |
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| Colorado |
Kentucky |
New Jersey |
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Texas |
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| Connecticut |
Louisiana |
New Mexico |
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Utah |
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| Delaware |
Maine |
New York |
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Vermont |
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| District of |
Maryland |
North Carolina |
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Virginia |
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| Columbia |
Massachusetts |
North Dakota |
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Virgin Islands |
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| Georgia |
Michigan |
Oklahoma |
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Washington |
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| Idaho |
Minnesota |
Oregon |
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West Virginia |
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| Illinois |
Mississippi |
Pennsylvania |
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Wisconsin |
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Missouri |
Puerto Rico |
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Wyoming |
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Rhode Island |
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United States***: |
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FECA |
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LHWCA |
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Special Provisions |
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| Arkansas.............. |
Employer
liability ceases six months after injury where no time is lost from work, or
six months after a claimant returns to |
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work,
or a maximum of $10,000 has been paid, unless the employer waives rights or
the Commission extends time and |
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dollar limits. |
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| California………… |
Chiropractic physical
therapy and occupational therapy visits limited to 24 per specialty. Insurer may authorize additional |
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visits. |
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| *See Introduction page. |
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| **No
time or monetary limitations. |
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| ***Federal
Employees' Compensation Act; |
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| Longshore and Harbor Workers' Compensation
Act. |
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TABLE 5a. MEDICAL BENEFITS PROVIDED BY WORKERS'
COMPENSATION STATUTES (cont.) |
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Special Provisions
(cont.) |
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| Florida............….. |
After
maximum medical improvement is reached, a $10 patient co-payment is required
for all medical services. If
injured |
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worker fails to show for
a scheduled independent medical examination, injured worker is liable for 50%
of the no show |
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fee charged by
provider. If an injured worker
requests an independent medical examination, he/she must pay for the |
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examination unless the
employee prevails in the medical dispute. |
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| Hawaii................ |
The
frequency and extent of treatment cannot exceed the nature of injury and the
process required for recovery. |
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Authorization is not required for the
initial 15 treatments of the injury during the first 60 calendar days. |
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| Ohio.................. |
After the employee has
received temporary total disability compensation for 90 days, the employee
must be examined by |
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the
Bureau of Workers' Compensation Medical Section to determine eligibility for
continuation of compensation and the |
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appropriateness of
medical treatment being provided. |
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| Montana............... |
A claimant copayment of
$25 for each subsequent visit to a hospital emergency department for
treatment is required, |
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unless the visit is for
treatment requested by an insurer. |
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| Tennessee............. |
Medical
benefits include psychological treatment if rendered by a psychologist and
upon the referral by a physician. |
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Medical treatment
required for a back injury shall include a chiropractor. |
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TABLE 5b.
METHODS OF PHYSICIAN SELECTION PROVIDED BY WORKERS' COMPENSATION
STATUTES |
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Employer |
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State Agency |
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Employee
Choice |
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Selection of |
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Selects |
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of Physician |
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Physician |
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Employer |
Initial Selection |
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Physician |
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| Initial |
Selection |
Selection |
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May be |
After |
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| Choice |
from list |
from list |
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changed by |
specified |
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prepared |
maintained |
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State |
periods |
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by State |
by employer |
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Agency |
stated in |
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Agency |
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law, |
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employee |
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has free |
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choice |
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| Alaska |
New York |
Florida 5/ |
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Alabama |
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Arkansas 2/ |
California 3/ |
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Puerto Rico |
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| Arizona 1/ |
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Georgia |
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Florida 6/ |
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Colorado |
Maine |
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| Connecticut 4/ |
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Tennessee |
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Indiana |
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Idaho |
Michigan |
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| Delaware |
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Virginia 15/ |
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Iowa |
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New Mexico |
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| District of |
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Kansas |
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Pennsylvania |
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| Columbia |
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Missouri |
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Utah 14/ |
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| Hawaii |
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New Jersey |
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Vermont |
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| Illinois |
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North Carolina |
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| Kentucky |
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Oklahoma 12/ |
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| Louisiana |
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South Carolina |
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| Maryland 7/ |
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| Massachusetts |
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| Minnesota 8/ |
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| Mississippi |
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| Montana 9/ |
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| Nebraska |
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| Nevada 10/ |
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| New Hampshire |
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| North Dakota 11/ |
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| Ohio |
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| Oregon |
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| Rhode Island |
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| South Dakota |
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TABLE 5b. METHODS OF PHYSICIAN SELECTION PROVIDED BY
WORKERS' COMPENSATION STATUTES (cont.) |
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Employer |
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State Agency |
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Employee
Choice |
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Selection of |
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Selects |
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of Physician |
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Physician |
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Employer |
Initial Selection |
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Physician |
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| Initial |
Selection |
Selection |
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May be |
After |
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| Choice |
from list |
from list |
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changed by |
specified |
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prepared |
maintained |
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State |
periods |
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by State |
by employer |
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Agency |
stated in |
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Agency |
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law, |
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employee |
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has free |
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choice |
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| Texas 13/ |
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| Virgin Islands |
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| Washington |
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| West Virginia |
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| Wisconsin |
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| Wyoming 16/ |
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| United States*: |
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| FECA |
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| LHWCA |
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| 1/
Arizona - If employer is self-insured, employer may choose physician, except
in emergencies. |
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| 2/
Arkansas- Employee may petition for a one-time change-of-physician. |
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| 3/
California - While employer has initial selection of physician, employee can
change to physician of own |
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choosing after 30 days,
and any worker who pre-designates a personal physician prior to injury |
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can
go to that physician after injury.
However, only employees who have employer provided |
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health coverage can predesignate. Note that rules for Health Care
Organizations, the |
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managed care component of California's
workers' compensation system, gives employers |
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longer periods of control of medical care. |
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| 4/
Connecticut - An employee has initial choice of physician only if employer
does not have a managed care plan |
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established. |
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TABLE 5b. METHODS OF PHYSICIAN SELECTION PROVIDED BY
WORKERS' COMPENSATION STATUTES (cont.) |
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| 5/
Florida - Employee selects from list supplied by carrier or managed care
organization when medical care |
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is provided through an
authorized managed care arrangement. |
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| 6/
Florida - If medical care is provided outside an authorized managed care
arrangement. |
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| 7/
Maryland - Employer selection of physician is also allowed, but is not
binding on employee. |
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| 8/
Minnesota - However, if there is a managed care plan in effect, employee is
obligated to see a |
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physician
in the plan network, unless a relationship has developed with a physician
outside |
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plan. Prior relationship is presumed if employee
has seen the physician twice within a two-year period. |
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| 9/
Montana - If employee is subject to a certified managed care plan, the MCO
chooses the physician. |
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| 10/
Nevada - Nevada's selection of physicians and chiropractors are governed by
NRS 616C.090; except in emergency, if the employer's |
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workers'
compensation insurer has entered into a managed care contract or health care
service provider |
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contract, the injured
employee must choose the treating physician or chiropractor or health care
service |
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provider according to the
terms of the contract. If the insurer
has not entered into such a contract, the |
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injured employee may
choose his treating physicians and chiropractors that DIR has
established. If the |
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injured
employee is dissatisfied with his initial treating doctor, he may choose an
alternative physician |
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or chiropractor within 90
days after his injury. |
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| 11/
North Dakota - Employers enrolled in North Dakota Workers’ Compensation’s
Risk Management Program |
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may select a designated
medical provider. |
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| 12/
Oklahoma - Employer makes initial choice of physician within first three days
of actual knowledge |
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of
employee injury or per a Cerified Workplace Medical Plan (CWMP) (Managed
Care). |
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If
emergency medical care is required or if the employer fails or neglects to
provide medical care, |
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then employee can choose
treating physician. |
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| 13/
Texas - Employee must make a selection from a list of physicians approved by
the Workers' |
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| 14/
Utah - Employee may make one choice of physician after initially seeing the
employer’s physician. |
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| 15/
Virginia - Employer’s list of physicians may also include chiropractors for
treatment of |
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employee’s injuries. |
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| 16/
Wyoming - Employee makes choice. |
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| * Federal Employees Compensation Act;
Longshore and Harbor Workers' Compensation Act. |
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