You must continue to visit one of these persons designated above, if you need treatment, for 90 days from the date of the first visit. If you do not comply with this requirement, your employer will be relieved from liability for payment of such services rendered during this period.
When reporting to a care facility simply tell the receptionist that T-Ross Brothers Construction, Inc is your employer and is affiliated with their Occupational Health Program.
As long as treatment is obtained from a designated provider during the 90-day period, all reasonable medical supplies and treatment related to the injury will be paid by the employer.
You have the right to switch from one designated health care provider on the list to another during the 90 day period and your employer must pay for this treatment provided you notify your employer of this change.
If you are referred to a non-designated provider, the designated provider must inform your employer.
You have the right to seek emergency medical treatment from any provider, but understand that a designated provider for the remainder of the 90-day period must render subsequent non-emergency treatment.
You have the right during the 90-day period to seek medical treatment from a non-designated provider, but understand your employer is not responsible to pay for these services.
After the 90-day period, you may choose to continue treatment with your own healthcare provider, and the company must pay for the treatment so long as the treatment is determined to be reasonable and necessary. The employee must notify his/her employer within five (5) days of any change of healthcare provider. If you fail to do so, your employer may not be responsible for treatment rendered by the non-designated provider prior to notification.
If a designated provider recommends invasive surgery, you are entitled to receive an additional opinion from any healthcare provider of your choice. If the additional opinion differs from that of the designated provider, you are entitled to select which course of treatment to follow. However, if you choose the recommendation of your healthcare provider (the additional opinion), the procedure shall be performed by one or more of the designated healthcare providers for a period of 90 days from the date of the visit to your healthcare provider (date of examination of the additional opinion).
Under this section of the law, you must acknowledge that we have notified you of your general rights and duties. Therefore, please sign your copy of this letter below and return it to your supervisor. If you have any questions on the above, please feel free to ask your supervisor or refer to Act 57 of the Pennsylvania Workers’ Compensation Act, (SB 801).
I have read, or have had read to me, and understand the above.