SEDGWICK PROVIDER NETWORK RULES for AK
Provider Selection
The employee chooses the treating provider.

Provider Lists/Panels
Provider Lists/Panels and directories may be utilized. There is no state-mandated posting.

Managed Care Options
Employers/insurers may use managed care services that do not interfere with the employee's choice of physician.

SEDGWICK PROVIDER NETWORK RULES for AL
Provider Selection
The employer/insurer chooses the treating provider without restriction.

Provider Lists/Panels
Provider Lists/Panels and directories may be utilized. There is no state-mandated posting, Sedgwick generic posting may be used.

Managed Care Options
There is no policy currently in effect that either explicitly prohibits or mandates managed care. There is an option of utilization review.

Additional Regulation
If an injured worker is unable to return to the preinjury job, the employer can require the employee to undergo vocational rehabilitation or the employee can request it.

SEDGWICK PROVIDER NETWORK RULES for AR
Provider Selection
The employer/insurer chooses the treating provider without restriction.

Provider Lists/Panels
Provider Lists/Panels and directories may be utilized. There is no state-mandated posting, Sedgwick generic posting may be used.

SEDGWICK PROVIDER NETWORK RULES for AZ
Provider Selection
If the Arizona employer is self-insured, the employer may direct medical care for injured employees under the provisions of A.R.S. § 23-1070, if they have provided the ICA a detailed statement of the arrangements between the self-insurer and medical provider, which includes:

The name, address, telephone number, fax number and email address for each medical provider included in the arrangement;
A description of services provided and how employees are informed of the services provided (e.g. bulletin notifications, payroll stuffers, etc.-Samples may be provided);
The effective date for services provided.

In lieu of providing a detailed statement of the arrangements, a self-insured employer may provide a copy of the applicable hospital or medical agreement for each provider.

Below is a link that shows self-insured employers approved by the Industrial Commission of Arizona (ICA) as well as those who can direct medical care.

http://www.ica.state.az.us/Homepage/HOME_NCCI_Redirect.aspx

Only the self-insured employers on this list are allowed to direct care in AZ.

Provider Lists/Panels
Provider Lists/Panels and directories may be utilized. There is no state-mandated posting.

Managed Care Options
The use of managed care practices is permitted as long as they do not interfere with the employee's right to choose the treating provider in the case of employers who are not self-insured.

Additional Regulation
Vocational rehabilitation is available to injured workers if they are unable to return to the preinjury type of employment after they are off work for 150 days. Worker participation is voluntary, with payment made from the IC's special fund.

SEDGWICK PROVIDER NETWORK RULES for CA
Provider Selection
Medical Provider Network: Unless the employee has predesignated (see below), the employer controls medical direction for the initial visit. Thereafter, the employee may change treating physicians, but only within the Medical Provider Network (MPN). Selection of a treating physician shall be based on the physician's specialty or recognized expertise in treating the injured worker's injury or condition.

Predesignation: If the employer provides nonoccupational group health coverage in a health care service plan or provides nonoccupational health coverage in a group health plan or health insurance policy the employee may notify his or her employer in writing prior to the date of injury that he/she wishes to be treated by his/her primary care physician who: has previously directed his/her medical treatment, retains the employee's medical records including medical history, and agrees to be predesignated.

Provider Lists/Panels
Medical Provider Network: Provider postings are permitted, and the employee may request access to the complete MPN. Access is available at this web-site, or by contacting the employer or at Sedgwick at 1-800-625-6588.

Managed Care Options
California Senate Bill 899 allows for the provision of a Medical Provider Network plan, and in addition to a medical provider network, the MPN plan allows for a process for second and third opinions, transfer of ongoing care, continuity of care, and independent medical review.

Utilization Management and Review
Utilization Review for medical services can be conducted for pre-authorization, concurrent review, and retrospective review. Utilization Review treatment guidelines follow the treatment guidelines of the Medical Treatment Utilization Schedule (MTUS). Chiropractic, occupational therapy, and physical therapy visits are capped at 24 visits each.

Additional Regulation
The employee can be held financially responsible for unauthorized care.

SEDGWICK PROVIDER NETWORK RULES for CO
Provider Selection
The employer/insurer chooses the initial treating provider. Within seven (7) business days following the date the employer has notice of the injury, the employer or insurer is required to provide the injured worker with a written designated provider list from which the injured worker may select a physician or corporate medical provider. If the employer fails to supply the required designated provider list in accordance with Colorado Rule 8, the injured worker may select an authorized treating physician or chiropractor of their choosing.

EXEMPTION: Employers that are health care providers or governmental entities that currently have their own occupational health care provider system may designated health care providers from their own system and other otherwise exempt from the requirement to provide a list of alternate physicians or corporate medical providers.

Provider Lists/Panels
The designated provider list must include contact information for the insurer of record including address, phone number and claims contact information. If the employer is self-insured, the contact information is required including the names and contact information of persons responsible for adjusting the claim. A Sedgwick generic posting meeting may be used if it includes the information. Alternatively, the designated provider list may be incorporated as part of the Workers' Compensation Act Poster, Form WC 49.

SEDGWICK PROVIDER NETWORK RULES for CT
Provider Selection
The employer is responsible for furnishing the emergency medical treatment at an employer-designated office or facility. After this initial treatment, the employee may choose an attending physician from the list of approved practitioners.

The list presently includes all physicians, surgeons, podiatrists, optometrists, and dentists licensed to practice in Connecticut.

Provider Lists/Panels
Provider Lists/Panels and directories may be utilized. Posting of a provider listing (panel) is required under a State Certified Managed Care Plan. Sedgwick generic posting may be used.

Managed Care Options
If an employer uses an approved medical care plan, then the employee must receive medical treatment from a participating medical practitioner. If the employee is treated outside the plan, all rights to WC benefits may be suspended by the WC commissioner.

SEDGWICK PROVIDER NETWORK RULES for DC
Provider Selection
The employee may select any licensed treating provider.

Provider Lists/Panels
Provider Lists/Panels and directories may be utilized. There is no state-mandated posting.

Managed Care Options
Insurers and others are permitted to provide managed care type services including case management and utilization review, however, the employee maintains choice of provider.

Additional Regulation
Cases are monitored for vocational rehabilitation after 90 to 120 days from the date of injury or when it becomes apparent that the worker will need retraining to return to gainful employment.

SEDGWICK PROVIDER NETWORK RULES for DE
Provider Selection
The employee chooses the treating provider without restriction.

Provider Lists/Panels
Provider Lists/Panels and directories may be utilized. There is no state-mandated posting.

Managed Care Options
Use of any managed care techniques must not interfere with the employees' rights regarding choice of physician.

SEDGWICK PROVIDER NETWORK RULES for FL
Provider Selection
The employer/insurer chooses the treating provider for situations other than managed care, or gives the injured employee a choice from the carrier's list of providers.

Provider Lists/Panels
Panel state. There is a State-mandated posting (Panel).

Managed Care Options
Treatment must be provided through managed care arrangements (MCA). In MCA, the injured employee chooses a designated physician gatekeeper (medical care coordinator) within the MCA's network of providers. MCC must be M.D. or D.O.

Additional Regulation
Carriers are not responsible for payment of unauthorized care unless awarded through state-mandated procedure.

Employee Education
The state has mandated that every employee be educated on their rights within the managed care plan. Employee rights documentation, Sedgwick ID cards and/or employee notices are available and distributed by Sedgwick.

SEDGWICK PROVIDER NETWORK RULES for GA
Provider Selection
The employee chooses a provider from a panel selected by the employer/insurer. The employer/insurer may choose listed providers without restriction. The employee may see providers not on the list if the employer/insurer authorizes them.

For employees whose insurers and/or employers have contracted with a certified managed care organization, initial choice of physician is limited to providers within the network.

Provider Lists/Panels
Panel state. GA form WC-P1 to be used to post panel. Legislation requires an orthopedic surgeon on the posted panel; it restricts industrial clinics to two, and requires a minority physician where feasible. The panel providers must not be associated (a group, professional association, or professional corporation counts as one provider). The employer/insurer may choose listed providers without restriction.

Managed Care Options
For employees whose insurers and/or employers have contracted with a certified managed care organization, initial choice of physician is limited to providers within the network.

Additional Regulation
Employee Bill of Rights to be posted along with panel.

Employee Education
Sedgwick ID cards and/or employee notices are available and distributed by Sedgwick. An employee must be given the "Employee Notice of Rights" with panel information.

SEDGWICK PROVIDER NETWORK RULES for HI
Provider Selection
The employee chooses the treating provider without restriction.

Provider Lists/Panels
Provider Lists/Panels and directories may be utilized. There is no state-mandated posting.

Managed Care Options
Employers and insurers may provide such services if they do not deny the employee's right to choose the treating physician.

Additional Regulation
After 120 days from the date of injury, vocational rehabilitation must be offered to a worker who is disabled if permanent disability is possible.

SEDGWICK PROVIDER NETWORK RULES for IA
Provider Selection
The employer/insurer chooses the treating provider.

Provider Lists/Panels
Provider Lists/Panels and directories may be utilized. There is no state-mandated posting, Sedgwick generic posting may be used.

Managed Care Options
Insurers/employers may provide such services as they deem necessary including contracting with managed care organizations. Employees can petition the commissioner for alternate medical care.

SEDGWICK PROVIDER NETWORK RULES for ID
Provider Selection
The employer/insurer can designate a particular provider or provider network for its injured workers (must be disclosed at time of hire and applied uniformly). However, when no provider is designated, the employee chooses the provider.

Provider Lists/Panels
Provider Lists/Panels and directories may be utilized. There is no state-mandated posting, Sedgwick generic posting may be used.

Managed Care Options
Employers/insurers may provide managed care services and generally must disclose the provider networks at the time of hire in order to direct care.

SEDGWICK PROVIDER NETWORK RULES for IL
Provider Selection
The employee chooses the treating provider.

Provider Lists/Panels
Provider Lists/Panels and directories may be utilized. There is no state-mandated posting. No postings are permitted.

Managed Care Options
The insurer/employer may offer managed care services to the extent practical; however, it must not deny an employee his or her choice of physician.

SEDGWICK PROVIDER NETWORK RULES for IN
Provider Selection
The employer/insurer chooses the treating provider.

Provider Lists/Panels
Provider Lists/Panels and directories may be utilized.

Managed Care Options
Insurers/employers may provide or contract with managed care and/or utilization review services.

SEDGWICK PROVIDER NETWORK RULES for KS
Provider Selection
The employer/insurer chooses the treating provider.

Provider Lists/Panels
Provider Lists/Panels and directories may be utilized. Although there is no state-mandated posting, Sedgwick generic posting must be used.

Managed Care Options
Insurers/employers may use such services including negotiating rates, and contracting with managed care organizations.

SEDGWICK PROVIDER NETWORK RULES for KY
Provider Selection
The employee chooses the treating provider.

Provider Lists/Panels
When no managed care contracts exist, Provider Lists/Panels and directories may be utilized. Where there is a managed care arrangement the employee must choose from a state-approved provider network listing, which can be obtained from the Managed Care partner.

Managed Care Options
Where an employer has contracted with an approved managed care plan, employees must choose one of the providers within the plan unless emergency care is needed.

Employee Education
When the employee chooses a provider for treatment of their work injury they are required to complete Form 113 - Notice of Designated Physician Form. Form 113 will be provided by the Managed Care partner or insurance company.

SEDGWICK PROVIDER NETWORK RULES for LA
Provider Selection
The employee chooses the treating provider without restriction.

SEDGWICK PROVIDER NETWORK RULES for MA
Provider Selection
The employee may select a treating health care professional. However, when a preferred provider arrangement (PPA) exists, the employer may select the provider for the first scheduled appointment.

Provider Lists/Panels
Provider Lists/Panels and directories may be utilized. There is no state-mandated posting.

Managed Care Options
Insurers, employers, and health care providers may enter into a preferred provider arrangement (PPA) for workers' compensation.

Additional Regulation
Employees subject to any PPA arrangement shall be provided information regarding their rights and obligations upon initial approval of the PPA and annually thereafter.

Employee Education
Such information (as above) shall also be posted in a prominent place in all worksites. Information is available through Sedgwick.

SEDGWICK PROVIDER NETWORK RULES for MD
Provider Selection
The employee chooses the treating provider.

Provider Lists/Panels
Provider Lists/Panels and directories may be utilized. There is no state-mandated posting.

Managed Care Options
Employers/insurers may provide managed care services that do not interfere with the employee's choice of physician.

SEDGWICK PROVIDER NETWORK RULES for ME
Provider Selection
The employer has the right to select a health care provider for the initial 10 days of medical care. After 10 days the employee may select a provider and provide the employer with the name and a statement of intention to treat with that provider.

Provider Lists/Panels
Provider Lists/Panels and directories may be utilized. There is no state-mandated posting, Sedgwick generic posting may be used.

Managed Care Options
There are no regulations by the WCB regarding managed care plans, however employers/insurers may provide such services that do not interfere with the provider choice provisions.

SEDGWICK PROVIDER NETWORK RULES for MI
Provider Selection
The employer/insurer has the right to select the treating provider for the first 28 days following the beginning of medical care.

Provider Lists/Panels
Provider Lists/Panels and directories may be utilized. There is no state-mandated posting, Sedgwick generic posting may be used.

Managed Care Options
Employers may contract with others to provide care at less than the fee schedule would pay in aggregate to manage their health care costs

SEDGWICK PROVIDER NETWORK RULES for MN
Provider Selection
The employee chooses the treating provider without restriction unless the employer or insurer has contracted with a certified managed care plan.

Within a certified plan the employee must select from the plan providers. However, the employee in a managed care plan may continue to treat with a doctor outside the plan with whom the employee has an established treating relationship.

Provider Lists/Panels
There is a state-mandated posting for the certified managed care program.

Managed Care Options
Employers/insurers may contract with one or more plans. If multiple plans exist, employee is allowed to choose plan. Providers in a certified MC program must be paid at fee schedule (i.e. no PPO discounts). Employer/insurer cannot own the MC program.

Employee Education
Employee education is regulated through managed care arrangement.

SEDGWICK PROVIDER NETWORK RULES for MO
Provider Selection
Except in an emergency, the employer has the right to select the treating provider. The employer must authorize all treatment. In an emergency the employee may be treated by the closest emergency room for the initial visit.

Provider Lists/Panels
Provider Lists/Panels and directories may be utilized. There is a state-mandated posting. The Sedgwick generic posting may also be used.

Managed Care Options
Employees subject to a managed care network cannot choose a provider outside of the plan.

Additional Regulation
Under managed care rules, the MCO must have vocational rehabilitation capabilities.

SEDGWICK PROVIDER NETWORK RULES for MS
Provider Selection
The employer must furnish the employee with a list of providers, however the employee may choose any treating provider. The employee's choice is limited to one provider and specialists to whom he is referred by that provider.

Also, referrals by the chosen physician are limited to one specialist and, except in emergencies, any additional referral must receive prior approval from the employer/insurer or the Workers' Compensation Commission.

Provider Lists/Panels
Provider Lists/Panels and/or directories may be utilized. There is no state-mandated posting, Sedgwick generic posting may be utilized.

Managed Care Options
Employers/insurers may contract with managed care organizations or use other managed care techniques that do not prohibit an employee from choosing the treating provider.

SEDGWICK PROVIDER NETWORK RULES for MT
Provider Selection
An employee chooses the treating physician, but if subject to a certified managed care plan, the MCO designates the treating physician.

Provider Lists/Panels
Provider Lists/Panels and directories may be utilized. There is no state-mandated posting unless there is a certified plan.

Managed Care Options
Montana insurers may contract with certified MCOs. Insurers may contract with multiple MCO's and allow the employees to choose an MCO.

SEDGWICK PROVIDER NETWORK RULES for NC
Provider Selection
The employer/insurer chooses the treating provider. If the employer/insurer does not direct, the employee can choose the provider or facility. The employee may choose in an emergency, but must notify the employer.

Provider Lists/Panels
Provider Lists/Panels and directories may be utilized. Form 17 is the state-mandated posting, Sedgwick generic posting may also be used.

Managed Care Options
In the case of employees subject to MCOs, the employee can change physicians once within the MCO's panel.

Additional Regulation
If the employer/insurer directs and the employee can reach this provider or facility, the employee must go there or be liable for the cost of treatment.

SEDGWICK PROVIDER NETWORK RULES for ND
Provider Selection
The employee has unrestricted choice of the treating provider, unless the employer is with an agency-approved risk management program.

Employers with an agency-approved risk management program are allowed to select designated providers to treat injured workers. Employees may opt out prior to sustaining a work injury.

Provider Lists/Panels
Provider Lists/Panels and directories may not be utilized. There is no state-mandated posting.

Managed Care Options
Required to establish a managed care program with a third party administrator by statute.

Additional Regulation
North Dakota has an exclusive state fund program.

SEDGWICK PROVIDER NETWORK RULES for NE
Provider Selection
Generally the employee selects the physician from a list provided by the employer. The employee can designate a provider who has treated the employee or a family member in the past (even if subject to a managed care contract).

If no employer notice was given, then the employee may make an initial selection of any physician, regardless of prior treatment.

Provider Lists/Panels
Provider Lists/Panels and directories may be utilized. There is no state-mandated posting unless within a certified plan, Sedgwick generic posting may be used.

Managed Care Options
Employees may choose among plans if multiple plans exist.

Additional Regulation
Form 50 "Choice of Doctor" must be completed.

Employee Education
Education of employees on their rights is mandatory, and should be arranged directly through the managed care program. ID cards and/or notices are available and distributed by Sedgwick.

SEDGWICK PROVIDER NETWORK RULES for NH
Provider Selection
The employee chooses the treating provider without restriction unless covered under a managed care contract. If subject to managed care, the employee must choose a provider within the plan.

Provider Lists/Panels
Provider Lists/Panels and directories may be utilized. Employees subject to MCO plan must be given a choice of two providers at each level of specialty including primary physician.

Managed Care Options
Managed care is mandated in the residual market and voluntary in other cases. MCOs may restrict access within the network pending the primary physician's direction. Employers or insurers are required to contract with a single state-approved plan only.

Employee Education
The state has mandated that every employee be educated on their rights within the managed care plan. Education is the responsibility of the managed care partner and should be arranged through that partner or Sedgwick.

SEDGWICK PROVIDER NETWORK RULES for NJ
Provider Selection
Except in an emergency the employer/insurer has the right to select the treating provider. In an emergency the employee is not restricted to the employer/insurer's choice.

Once an emergency no longer exists, the employer/insurer may require treatment by an authorized provider.

Provider Lists/Panels
Provider Lists/Panels and directories may be utilized. There is no state-mandated posting, Sedgwick generic posting may be used.

Managed Care Options
MCOs must ensure that employees will be directed to appropriate care and provide medical case management services based on established treatment protocols.

SEDGWICK PROVIDER NETWORK RULES for NM
Provider Selection
The employer/insurer now has the option to control provider choice either during the first 60 days following the injury or, if the employee makes the initial choice, after this initial 60-day period.

Provider Lists/Panels
Provider Lists/Panels and directories may be utilized. There is no state-mandated posting, Sedgwick generic posting may be used.

Managed Care Options
Payers may use managed care services that do not conflict with choice of provider rules.

SEDGWICK PROVIDER NETWORK RULES for NV
Provider Selection
The employer can direct medical care. The employee can change treating providers once in the first 90 days. However, the new provider must be in network.

Provider Lists/Panels
Provider Lists/Panels and directories may be utilized. There is no state-mandated posting. If a contract with an MCO exists, Sedgwick generic posting may be used.

Managed Care Options
A self-insured employer or employer's insurer may enter into a contract with an MCO. If a required service is not available through a plan, the employee may request that a nonplan provider be allowed to furnish services.

SEDGWICK PROVIDER NETWORK RULES for NY
Provider Selection
Unless in a certified program the employee must select the treating provider from an extensive list of authorized providers developed by the Workers' Compensation Board (WCB).

Employers may recommend preferred providers to injured workers with their written consent post-injury.

Provider Lists/Panels
Provider Lists/Panels and directories may be utilized in all counties.

Managed Care Options
Certified PPO program: Employees have restricted choice of provider − employees working within certified counties are required to treat with a PPO provider for up to 30 days after the initial treatment by a PPO provider.

Additional Regulation
Certified PPO program: employees must be given a written description of the program pre-injury, and the Employee Handbook post-injury or upon request. These employee notices and handbooks are available and distributed by Sedgwick Pre-Injury Consultant.

Employee Education
The state has mandated that every employee be educated on their rights within the certified PPO plan.

SEDGWICK PROVIDER NETWORK RULES for OH
Provider Selection
For self insureds, employee chooses from a BWC certified provider. Employers cannot direct care.

Provider Lists/Panels
Provider Lists/Panels and directories may be utilized. There is no state-mandated posting requirement, Sedgwick generic posting may be used. Caution must be exercised by not mandating specific providers. Employers can recommend but not mandate use of medical providers or facilities.

Managed Care Options
For self insured's who are members of the qualified managed care program (QHP), employees may be restricted to choosing a provider within that program. However, most self inured employers have opted out of the QHP program in Ohio. If an employer has opted out injured workers can select any medical provider that is BWC certified. For statefund employers, MCO's must be certified by the state.

Additional Regulation
Ohio has an exclusive state fund program, employers are allowed to self insure.

SEDGWICK PROVIDER NETWORK RULES for OK
Provider Selection
The employee selects the treating provider. If covered by a certified workplace medical plan (CWMP), the employee must choose a plan provider or a physician who has maintained the medical records of the employee or a member of their immediate family.

Provider Lists/Panels
Provider Lists/Panels and directories may be utilized. There is no state-mandated posting, Sedgwick generic posting may be used.

Managed Care Options
The employer or the insurer may contract with a CWMP. A managed care plan must provide aggressive case management for injured employees and a program for early return to work in order to be certified.

Employee Education
The state has mandated that every employee be educated on their rights within the managed care plan, and must individually sign a statement that this requirement has been met and that they elect to participate in the plan.

SEDGWICK PROVIDER NETWORK RULES for OR
Provider Selection
Employee chooses without restriction unless a contract with a managed care organization (MCO) exists. Where an MCO contract exists the injured worker may be required, on a case-by-case basis, to receive medical services immediately from an MCO provider.

Provider Lists/Panels
Provider Lists/Panels and directories may be utilized. For an MCO, there is a state-mandated posting, which is distributed by the Managed Care partner. Panels must include a minimum of one attending physician for every 1,000 workers covered. If no MCO exists, then no posting is permitted..

Managed Care Options
The state certifies MCO's. If a worker is required to get services from the MCO, payment of reasonable medical costs (not covered by health insurance) must be guaranteed even if the claim is denied, until the worker receives notice of the denial.

Additional Regulation
An employee must be given the "Employee Notice of Rights". Unless provider is covered by MCO contract employee can change provider twice.

Employee Education
The state has mandated that every employee be educated on their rights within the managed care plan. Education can be facilitated through Sedgwick.

SEDGWICK PROVIDER NETWORK RULES for PA
Provider Selection
Employer/insurer may direct for the first 90 days of treatment after the first visit, by use of a panel posting. If there is no list, the employee can select the treating provider.

Provider Lists/Panels
Provider Lists/Panels and directories may be utilized. There is a state-mandated posting (Panel). The panel must include at least six designated providers. Four may be coordinated care organizations (CCO), and no fewer than three must be physicians.

Additional Regulation
The employee may choose a physician outside of the CCO after the initial 90 days of treatment.

Employee Education
Employee education facilitated through Sedgwick.

SEDGWICK PROVIDER NETWORK RULES for RI
Provider Selection
The employee is free to choose the first treating provider without restriction. Treatment provided at an emergency room after the accident or by a physician under contract with the employer does not count as the first medical care provider.

Provider Lists/Panels
Provider Lists/Panels and directories may be utilized. There is no state-mandated posting.

Managed Care Options
PPO network arrangements registered with the state allow an employer to direct at change of provider.

SEDGWICK PROVIDER NETWORK RULES for SC
Provider Selection
The employer/insurer chooses the treating provider.

Provider Lists/Panels
Provider Lists/Panels and directories may be utilized. There is a state-mandated posting. The Sedgwick generic posting may also be used.

SEDGWICK PROVIDER NETWORK RULES for SD
Provider Selection
Employees choose from members of the managed care program. However, employees may choose a provider outside of the plan if they notify the plan of the selection of a nonparticipating provider before treatment.

Provider Lists/Panels
Provider Lists/Panels and directories may be utilized. There is a state-mandated posting (Panel), which is distributed by the Managed Care partner.

Managed Care Options
All employees are to be covered under a state certified managed care plan. The employee can change the treating provider with the written approval of the employer/insurer or the plan. Providers must abide by plan rules including referral within plan.

Additional Regulation
An employee must be given the "Employee Notice of Rights".

Employee Education
The state has mandated that employees be educated on their rights within the managed care plan.

SEDGWICK PROVIDER NETWORK RULES for TN
Provider Selection
The employee chooses the treating provider from a list developed by the employer/insurer.

Provider Lists/Panels
Provider Lists/Panels and directories may be utilized. There is a state-mandated posting (Panel) − Form C−42. The panel must include three or more providers.

SEDGWICK PROVIDER NETWORK RULES for TX
Texas Healthcare Network (TX HCN)

Texas HB7 allows for the provision of a Certified Healthcare Network plan. In order for an employee to be deemed participating in the HCN, the employer must have provided all employees a copy of HCN Employee notification packet.
HCN Employee Notification: Employee notification documents are to be given to the employee at enrollment and again at the time of injury. New employees must receive these documents within 3 days of hire.

Provider Selection
Unless covered by the TX HCN, the employee is entitled to initial choice of treating doctor.

TX HCN: Unless the employee has predesignated a provider, or requires emergency medical attention, the employee must choose a provider from the list of HCN providers within the employees General Service Area (GSA).

TX HCN Predesignation: If the employer provides HMO coverage for group health, the employee may notify the employer in writing prior to the date of injury that they wish to be treated by a primary care physician who has previously directed medical treatment for the employee. The provider must have communicated to the HCN their agreement to abide by the rules and regulations of the HCN prior to the injury.

Provider Lists/Panels
A provider list and directory may be utilized.
TX HCN: Provider postings are permitted, and the employee may request access to the providers within his/her GSA.
Non-Sub Clients: For non-subscriber programs, panels may be created.

Additional Regulation
Non HCN: In the event of an emergency or when selected by the employer/insurer, the initial choice of doctor is not considered to be the employee's choice, unless treatment continues for more than 60 days.
TX HCN: In the event of an emergency the employee may choose any provider, but must transfer to an HCN provider upon discharge.
TX HCN: Under the HCN, the employee can be held financially responsible for unauthorized care.

SEDGWICK PROVIDER NETWORK RULES for UT
Provider Selection
The employer/insurer has the right to select the initial treating provider. If this right is not exercised, the employee is free to make the choice.

Provider Lists/Panels
Provider Lists/Panels and directories may be utilized. There is no state-mandated posting, Sedgwick generic posting may be used.

Managed Care Options
Employers/insurers may set up a managed health care plan including a preferred provider program. If notified of the program a worker who fails to use the program initially (first visit) may be obligated to pay any charges in excess of the PPO rate.

SEDGWICK PROVIDER NETWORK RULES for VA
Provider Selection
The employee must select a provider from a list developed by the employer/insurer. If no panel is offered, the employee may choose the provider.

Provider Lists/Panels
Panel State. Provider Lists/Panels and directories may be utilized. There is a state−mandated posting, (Form VWC1). The panel must include three or more providers (per specialty listed).

SEDGWICK PROVIDER NETWORK RULES for VT
Provider Selection
The employer/insurer has the right to choose the initial treating provider. Employee may change providers upon giving the employer written notice.

Provider Lists/Panels
Provider Lists/Panels and directories may be utilized. There is no state-mandated posting, Sedgwick generic posting may be used.

SEDGWICK PROVIDER NETWORK RULES for WA
Provider Selection
The employee is free to choose the initial treating provider.

Provider Lists/Panels
Provider Lists/Panels and directories may be utilized. There is no state-mandated posting. No postings are permitted.

Additional Regulation
Exclusive State Fund.

SEDGWICK PROVIDER NETWORK RULES for WI
Provider Selection
Except in an emergency, the employee selects without restriction a treating provider licensed in and practicing in Wisconsin. In an emergency, the employer/insurer may select the treating provider.

(When the emergency has ended, choice of the treating provider reverts to the employee.)

Provider Lists/Panels
There is no state-mandated posting. Postings may be informational but can not direct employees to providers.

Managed Care Options
Employers are allowed to contract with HMO's. However, employees retain the choice of initial treating provider.

SEDGWICK PROVIDER NETWORK RULES for WV
Provider Selection
The employee chooses the initial treating provider without restriction.

Provider Lists/Panels
There is no state-mandated posting. Postings may be informational but can not direct employees to providers.

Managed Care Options
If the employer has contracted with an HMO the employee still chooses the initial treating provider but subsequent choices must be made within the HMO.

Additional Regulation
Exclusive State Fund.

SEDGWICK PROVIDER NETWORK RULES for WY
Provider Selection
The employee can designate the treating provider, but the employer or the fund may select another provider for a second opinion without restriction.

Additional Regulation
Exclusive State Fund.