Rule 50: Choice of Physician
Rule 50: Choice of Physician
Nebraska Workers' Compensation Court Rules
Sections 48-163, 48-164, R.S. Supp. 2024; sections 48-120, 48-120.02, 48-165, 48-173, R.R.S. 2021.
Effective date: December 20, 2018.
Nebraska Workers' Compensation Court Rules
Sections 48-163, 48-164, R.S. Supp. 2024; sections 48-120, 48-120.02, 48-165, 48-173, R.R.S. 2021.
Effective date: December 20, 2018.
A. Employee’s Choice.
1. If the employer does not give the employee notice, as described in Rule 50,B,2, of the right to choose a family physician as the primary treating physician, the employee is free to choose any physician qualified to treat the injury as the primary treating physician.
2. If the employer gives the employee notice, as described in Rule 50,B,2, the employee has the right to choose a family physician as the primary treating physician. As soon as possible after getting the notice, the employee must give the employer the name of the family physician chosen. The employee must do this before receiving any treatment, unless it is emergency medical treatment. If the employee does not do this, the employer has the right to choose the primary treating physician.
3. The employer may ask the family physician chosen by the employee for a letter to verify prior treatment. If an authorization is needed, the employee or immediate family member must give it. If it is not given, the employer has the right to choose the primary treating physician.
4. The employee may not change the primary treating physician chosen according to Rule 50,A,2 unless the employer agrees or the compensation court orders the change. A referral by the primary treating physician is not a change.
5. The employee may choose the physician to do surgery when the injury involves dismemberment or a major surgical operation.
6. The employee may choose a physician if compensability is denied and the employer will pay for medical, surgical, or hospital services later found to be compensable.
7. If the primary treating physician chosen by the employer refuses to provide certain medical services and those services are later ordered by the compensation court, the employee can choose a physician to furnish further services.
B. Employer’s Choice.
1. The employer may have the right to choose an injured employee’s primary treating physician. If the employer wishes to choose, the employer must first give the employee notice, following an injury, of the right to choose a family physician as the primary treating physician.
2. The court has a form the employer may use to give notice to the employee. In all cases, the notice:
a. must be given to the employee as soon as possible after the employer knows about the injury;
b. must tell the employee of the right to choose a family physician as the primary treating physician;
c. must tell the employee to give the employer the name of the family physician chosen as the primary treating physician as soon as possible after getting notice from the employer, and before any treatment, unless it is emergency medical treatment;
d. must tell the employee the employer gets to choose the primary treating physician if the employer is not given the name of the family physician as soon as possible after the employee receives the notice;
e. must tell the employee the employer gets to choose the primary treating physician if an authorization is needed to verify prior treatment and is not given; and
f. must tell the employee the primary treating physician may not be changed once the employer has been given the name, unless the change is agreed to by the employer or is ordered by the compensation court. A referral by the primary treating physician is not a change.
3. The employer may ask the family physician for a letter to verify prior treatment. If an authorization is needed, the employee or immediate family member must give it.
4. The employer can choose the primary treating physician following notice to the employee if:
a. the employee has no family physician; or
b. there is a family physician but the employee does not tell the employer the name of the family physician as soon as possible after getting notice from the employer; or
c. if authorization to verify treatment by the family physician is not given.
5. If the employee lives or works in a city of 5,000 or more, the primary treating physician chosen by the employer must be within 30 miles of where the employee lives or works. If the employee lives and works outside a city of 5,000 or more, the physician must be within 60 miles of where the employee lives or works. If there is no physician qualified to treat the injury within these mileage limits, they do not apply.
6. The employer may not change the choice of the primary treating physician made according to Rule 50,B,4, unless the employee agrees or the compensation court orders a change. A referral by the primary treating physician is not a change.
7. The employer does not have to give the employee notice of the right to choose a family physician as the primary treating physician. If the employer does not give notice, the employee is free to choose any physician qualified to treat the injury as the primary treating physician.
C. Change of Physician. Following notice as described in Rule 50,B,2 if the primary treating physician has been chosen by the employee according to Rule 50,A,2 or by the employer according to Rule 50, B,4, there can be no change in the primary treating physician unless the employee and employer agree or the compensation court orders a change.
D. Referrals. The primary treating physician may arrange for specialized medical services the employee needs. A referral by the primary treating physician is not a change. The rules of the managed care plan will apply to referrals made by a participating or nonparticipating physician under a managed care plan.
E. Inability to Follow Rule 50 for Choice of Primary Treating Physician. An employer and/or employee may be unable to follow Rule 50 to choose the primary treating physician. This may happen if the injury takes place away from the employer’s place of business or because of the type of injury. Rule 50 will not apply to choosing the primary treating physician as long as this inability lasts.
F. Travel Expenses. If the employee chooses a physician from a community other than where the employee lives or works, and if a physician is available in a closer community, the employer does not have to pay travel expenses.
G. Effective Date. If the employer received notice of the injury before January 1, 1994, the employee may continue to receive services for that injury from a physician selected prior to that date.