In Texas, an injured worker’s right to choose a treating provider depends on whether the employer participates in a Workers’ Compensation Health Care Network (HCN) or a non-network system.
Determine Network Participation
Before beginning treatment, providers should determine whether the injured worker’s employer is covered by a certified workers’ compensation health care network (HCN).
- If the employer participates in a network, the injured worker must select a treating doctor from the network’s approved provider list.
- The employer is required to provide the injured worker with a list of network providers.
- Only providers listed in the network are eligible to treat injured workers if the employer participates in an HCN.
If a provider is not part of the employer’s network, the provider cannot treat the injured worker unless the network explicitly authorizes the provider to furnish care.
Non-Network
If the employer does not participate in a certified health care network (HCN), the injured worker may choose any physician who treats workers’ compensation patients.
However certain providers are restricted from treating injured workers in Texas. The DWC maintains a list of restricted providers on the following DWC website:
Disciplinary orders against health care practitioners (HCPs)
When a provider violates statutes, commits fraud, or fails to meet qualification or credentialing requirements, the Texas DWC prohibits these providers from treating injured workers.
Provider Best Practices
To ensure compliance and reimbursement:
- Verify the employer’s network status before scheduling treatment.
- Document the injured worker’s physician's choice in the medical record.
- Educate provider staff to identify network participation requirements before treatment.
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6. How can i find a doctor who will treat me for my injury? How you find a treating doctor depends on how your employer has set up their workers’ compensation coverage. Some employers choose to provide coverage through a certified health care network, while others don’t. If your employer is in a network, you must choose a doctor from the network’s provider list. Your employer can give you this list. If your employer isn’t in a network, you can ask your current doctor if he or she treats workers' compensation patients. If the answer is “no”, ask your doctor to help you find a doctor who does. You can also ask your doctor’s staff, your family, and friends if they know doctors who treat workers' compensation patients.
Here is a list of doctors who are not allowed to treat workers' compensation patients in Texas. When you find a doctor give them:
Changing your doctor If your employer provides care through a network and you are not happy with your doctor, you can pick a new doctor from the list. You must contact the network to let them know, and the network can’t deny your request. If you are not happy with the new doctor, the network may have to approve the next change.
If you are not covered by a network, you have to ask DWC to approve your request to change doctors.
Use DWC Form-053, Employee’s Request to Change Treating Doctor. |
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