DELAWARE COUNTY
STATE WORKER’S INSURANCE FUND
Worker’s Compensation Program: Designated Health Care Providers
NOTICE TO EMPLOYEES IN CASE OF WORK-RELATED INJURIES
If you suffer a work-related injury, immediately report the injury to your supervisor. Failure to do so may delay your benefits or may cause you t lose your rights to benefits. For necessary medical treatment and supplies to be paid by your employer.
- All treatment must be obtained from one of the health care providers listed below.
- You must continue to visit one of the health care providers listed below if you need treatment for 90 days from the date of your first visit. If one of the providers listed below refers you to another licensed specialist, those services will be paid.
- After this 90-day period, if you still need treatment, you may go to another health care provider for treatment as long as you notify your claims adjuster within five (5) days of your visit to a new provider.
- If a listed physician prescribes invasive surgery, you have the right to obtain a second opinion from a physician of your choice. If a second opinion differs from that of the listed physician’s opinion, you may determine which course of treatment to follow; however, the second opinion must contain a detailed treatment plan. If you choose the treatment prescribed in the second opinion, you must receive the treatment from a listed provider for a period of 90 days after the date of your visit to the provider of the second opinion.
If you are faced with a medical emergency, you may secure initial emergency treatment from any emergency facility. However, when the emergency is resolved, follow-up treatment must be obtained from one of the following health care providers. If you choose to treat with an out-of-state provider, you may be subject to balance billing.
| NAME OF PROVIDER | ADDRESS | CITY, STATE, ZIP | PHONE | SPECIALTY |
| Aston Medical Associates | 5027 Pennell Road | Aston, PA 19014 | 610.497.4040 | Family Practice |
| Brookhaven Medical Associates | 4000 Edgemont Avenue | Brookhaven, PA 19015 | 610.876.3500 | Family Practice |
| Painters Plaza Family Medical | 1290 Baltimore Pike | Chadds Ford, PA 19317 | 610.459.3048 | Family Practice |
| Chester Family Practice | 521 East 9th Street | Chester, PA 19013 | 610.872.0565 | Family Practice |
| Radnor Family Practice | 427 E. Lancaster Ave. | Wayne, PA 19087 | 610.688.8807 | Family Practice |
| Han Neurology | 2100 Keystone Avenue | Drexel Hill, PA 19026 | 610.394.4731 | Neurology |
| WORKNET Occupational Medicine | 100 Diplomat Drive, Bay 1 | Lester, PA 19113 | 610.521.6880 | Occ. Medicine |
| Negrey-Jahnie Eye Associates | 56 West Eagle Road | Havertown, PA 19083 | 610.446.8080 | Opthalmology |
| Reconstructive Ortho. Assoc. | 830 Old Lancaster Road | Bryn Mawr, PA 19010 | 267.339.3558 | Orthopedics |
| Rothman Institute | 1118 West Baltimore Pike | Media, PA 19063 | 800.321.9999 | Orthopedics |
| Rothman Institute | 3855 West Chester Pike | Newton Square, PA 19073 | 800.321.9999 | Orthopedics |
| Founders Physical Theraphy | 101 S. Bryn Mawr Ave., Ste.202 | Bryn Mawr, PA 19010 | 866.446.2848 | Physical Theraphy |
| Ralph Carrozza, DC | 200 Lawrence Rd., Ste. 300 | Broomall, PA 19008 | 866.446.2848 | Chiropractic |
| John Pandolfo, DC | 3726 Garrett Rd. | Drexel Hill, PA 19026 | 866.446.2848 | Chiropractic |
| Jarrad Teller, DC | 7016 Terminal Square, Ste. 10-A | Upper Darby, PA 19082 | 866.446.2848 | Chiropractic |
FOR PRESCRIPTION MEDICATIONS AND DURABLE MEDICAL EQUIPMENT OR
TO SCHEDULE PHYSICAL THERAPHY, CHIROPRACTIC AND DIAGNOSTIC IMAGING
APPOINTMENTS AND LOCATIONS CLOSE TO YOU PLEASE CALL
KEYSCRIPTS
1.866.446.2848
Some of your health care provider bills and reports need to be sent to the following address for review and payment in accordance with the Pennsylvania Workers’ Compensation Act:
State Workers’ Insurance Fund, 100 Lackawanna Avenue, P.O Box 5100, Scranton, PA 18505-5100
Phone: 570.963.4635 Fax: 570.963.4261
NOTICE: MEDICAL TREATMENT FOR YOUR WORK INJURY OR OCCUPATIONAL ILLNESS
Your employer has selected a list of 6 or more physicians and other health care providers who are available to treat your work-related injuries and illnesses during the first 90 days of treatment. This is posted at Sandra Turner’s desk in Billing dept. for you to view. Also, you may get a copy of this list from Sandra Turner.
MEDICAL TREATMENT: DURING THE FIRST 90 DAYS
- You have the RIGHT to receive reasonable and necessary medical treatment for your work injury or occupational illness. Your employer must pay for the treatment, as long as the treatment is by one of the listed providers.
- You have the RIGHT to choose which of the listed providers will treat you for your work injury or illness.
- You have the RIGHT to switch among any of the listed providers when you receive treatment; and if a listed provider refers you to a provider not on your employer’s list, you have the RIGHT to receive treatment from the referral provider.
- You have the RIGHT to receive emergency medical treatment from any provider. However, non-emergency treatment must be given by a listed provider.
- If a listed provider prescribes surgery for you, you have the RIGHT to receive a second opinion from any provider
of your choice. If that opinion is different from the opinion of the listed provider, you have the RIGHT to choose which course of treatment to follow. If you choose the treatment prescribed in the second opinion, you must receive the treatment from a listed provider for a period of 90 days after the date of your visit to the provider of the second opinion.
- You have the DUTY to visit one or more of the listed providers for the first 90 days of treatment for your work injury or illness if you expect your employer to pay for the medical treatment you receive.
- If you seek treatment for your work injury or illness from a provider who is not on the list, your employer may not have to pay for this medical treatment during this 90-day period. Therefore, you should talk to your employer before seeking treatment from a provider who is not on the list.
IMPORTANT: The requirements your employer must meet to have a valid list of at least 6 providers are shown n the reverse side of this form. If the list does not meet these requirements, it is not a valid list, and you have the right to seek medical treatment for your work injury or occupational illness from any health care provider of your choice.
MEDICAL TREATMENT: AFTER THE FIRST 90 DAYS
- You have the RIGHT to receive treatment from any physician or other health care provider of your choice, whether or not they are listed by your employer. Your employer must pay for this treatment , as long as it is reasonable and necessary for your work injury or occupational illness and has been properly documented by the physician or other health care provider.
- You have the DUTY to notify your employer if you receive treatment from a physician or other health care provider who is not listed by your employer. You must notify your employer within five days of the first visit to any provider who is not on your employer’s list. The employer may not be required to pay for treatment received until you have given this notice
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