Around the States
Who chooses the treating physician, when can the worker change physicians, and how much control does the employer/carrier have?
Current reference: September 2026
Workers’ compensation systems take markedly different approaches to medical-provider selection.
Some jurisdictions give the injured worker broad authority to select a treating physician. Others give the employer or insurer primary control. Still others use panel, preferred-provider, managed-care or medical-provider-network systems that divide responsibility between the parties.
For claims professionals, the critical question is not simply “Who chooses the doctor?” It is:
Who controls medical treatment at each stage of the claim?
This chart therefore identifies the initial selection method, the worker’s ability to change physicians, and significant network/panel or direction-of-care requirements.
50-State Chart
StateInitial Choice / Direction of CareEmployee’s Ability to Change PhysicianKey Direction-of-Care RuleAlabamaEmployerOne change from employer’s panel of four, with employer/insurer approval and dissatisfaction with careEmployer-directed system; panel mechanism applies to physician changeAlaskaEmployeeOne change without restriction; additional changes require written employer/insurer approvalEmployer may provide preferred-provider list, but must tell employee use of list is not mandatoryArizonaEmployee, unless self-insured employer directs careChange with treating-doctor approval, carrier approval, or Industrial Commission approvalSelf-insured employers can direct careArkansasEmployer / managed care organizationOne-time change through Commission; may select within MCO or regular treating physician under statutory conditionsIf no MCO, employee may use a physician associated with a certified MCO or regular treating physicianCaliforniaHybrid — MPN/employer control, with predesignation exceptionWithin MPN, employee may change physicians after initial evaluation; without MPN/predesignation, employee gains broader choice after 30 daysEmployee may predesignate personal physician if statutory requirements are satisfiedColoradoEmployee chooses from employer-provided list of fourSeveral avenues: employer/insurer approval, agency order, treating-physician referral, or insurer failure to respond within 20 daysRural-area exceptions applyConnecticutEmployee; must use network if managed-care plan appliesCommission order, insurer approval, or hearingManaged-care plan can restrict initial provider choice to networkDelawareEmployee, generally from state-provided listEmployee may choose/change physician at any timeEmployee may use provider outside list if employer preauthorizesFloridaEmployer/carrierOne-time change upon written requestCarrier generally controls authorized treating physician; employee receives one statutory changeGeorgiaEmployee chooses from employer panel of at least six or managed-care planOne free change from one panel physician to anotherPanel must satisfy statutory requirements; managed-care arrangements can alter selectionHawaiiEmployeeAdditional changes may be requested; generally one change per case absent good/valid reasonsEmployee has broad physician-choice rightsIdahoEmployer may direct initial care; if it does not, employee may obtain reasonable careChange with employer/insurer approval, treating-physician referral, or Industrial Commission petitionEmployer direction is permitted but not automaticIllinoisEmployeeTwo free choices of physician; additional providers may flow from referralsUtilization review can restrict treatment even though physician choice is broadIndianaEmployerChange requires employer/insurer approvalEmployer-directed careIowaEmployerChange requires agency order or employer/insurer/self-insurer approvalEmployer-directed careKansasEmployerBy agreement or administrative-law-judge orderPhysical therapy beyond 21 visits requires authorizationKentuckyEmployee, unless employer has managed-care planOne change for any reason; later changes require reasonable causeManaged care is optional; if employer has a plan, employee must use plan providersLouisianaEmployeeOne treating physician in any field/specialty; subsequent same-specialty change generally requires consent; change to another specialty does not require same approvalEmployee has an important statutory physician-of-choice rightMaineEmployer for first 10 days; employee thereafterOne change with notice; employer/insurer may contestEmployer loses initial medical control after 10 daysMarylandEmployeeAt any timeBroad employee choiceMassachusettsEmployeeOne change without consent unless preferred-provider agreement applies; second change requires insurer/self-insurer approvalPreferred-provider agreements can restrict choiceMichiganEmployer for first 28 days; employee thereafterEmployee can change after 28-day employer-control period by notifying employer/carrierImportant statutory transition from employer to employee choiceMinnesotaEmployeeChange within 60 days without approval; after 60 days, insurer/self-insurer approval generally requiredCertified managed-care plans can require network providers unless employee has documented treatment history with another providerMississippiEmployeeChanges may require agency order, insurer approval, or other statutory authorizationEmployee initially selects treating physicianMissouriEmployerChange by ALJ order or employer/insurer approvalEmployer-directed modelMontanaEmployee initiallyChange with employer/insurer approvalAfter insurer accepts liability, insurer may designate a treating physician and transfer careNebraskaEmployeeChange by agreement of employee and employer/insurer or court orderEmployee has initial choiceNevadaEmployee selects from insurer’s treating-provider panelWithin first 90 days and thereafter with written request/insurer approvalEmployee chooses from insurer’s statutory provider listNew HampshireEmployee, or within employer MCO if applicableNo specific statutory change provisionManaged-care participation can affect provider selectionNew JerseyEmployerEmployer/insurer approval or Workers’ Compensation Court orderEmployer-directed systemNew MexicoEmployer may direct first 60 days; alternatively worker may select and other party can direct next 60 daysIf employer directed first 60 days, employee can change after that periodOne of the more unusual rotating-control systemsNew YorkEmployee, from Board-authorized providersEmployee may change provider at any time; PPO participants have additional restrictions during initial periodPPO participation can restrict choice; extensive treatment guidelines applyNorth CarolinaEmployerChange generally requires Industrial Commission approvalEmployee may obtain additional consultations in circumstances permitted by statuteNorth DakotaEmployeeChange requires Workers’ Compensation agency approvalEmployer may designate a provider, but employee may retain choice if provider was designated before injuryOhioEmployeeEmployee can change physician at any timeProvider must be BWC-certifiedOklahomaEmployer, except emergency or failure/refusal to provide careOne change upon petition to Workers’ Compensation CommissionEmployer direction is subject to statutory exceptionsOregonEmployee, including within MCO when applicableTwo changes by choice; additional changes may be requestedMCO participation can limit provider selection to MCO panelPennsylvaniaEmployee from employer-provided listMust use list for first 90 days; after 90 days may choose provider, with five-day notice to employerIf employer fails to provide a valid list, employee may choose physicianRhode IslandEmployeeBroad choice; if approved preferred-provider network exists, change must generally remain within networkNetwork arrangements can restrict physician changesSouth CarolinaEmployerAdditional changes through agency or employer/insurer approvalEmployer has initial controlSouth DakotaEmployeeChange requires employer/insurer approvalEmployee-choice system with controlled changesTennesseeEmployee chooses from employer list of three or moreCourt/insurer approval depending on date of injury and applicable procedurePanel/list system; post-2014 claims involve Court of Workers’ Compensation ClaimsTexasEmployee in non-network claims; network claims use network rulesNon-network changes may require DWC approval; network changes follow network proceduresCertified workers’ compensation health-care networks substantially change provider-choice rulesUtahEmployer’s preferred provider, if declared; otherwise employee gets one choiceOne change without approval; additional change requires employer/insurer preauthorizationPreferred-provider designation is central to Utah’s systemVermontEmployerEmployee may elect to change employer’s provider at any time by written noticeEmployer initially selects, but employee has unusually broad change rightVirginiaEmployee chooses from employer-provided panelChange through Commission, insurer/self-insurer approval, or agency processPanel system; employer supplies physician choicesWashingtonEmployee, from workers’ compensation networkEmployee may change treating physician as long as new physician is in authorized networkInitial emergency/office care can precede network selectionWest VirginiaEmployee, unless approved managed-care plan appliesChange with insurer/self-insurer approvalManaged health-care plans can require participating providersWisconsinEmployeeEmployee can change with notice; additional changes may require employer/insurer approvalBroad employee choiceWyomingEmployee, after any required employer on-site providerChange requires employer/insurer approvalEmployer may require initial treatment from an on-site provider, after which employee selects treating provider
The 50 states can be broadly understood through three medical-provider models.
1. Employer-Directed Care
The employer or insurer has substantial control over the treating physician.
Examples include:
Alabama • Florida • Indiana • Iowa • Missouri • New Jersey • North Carolina • Oklahoma • South Carolina
These states tend to give the employer/carrier greater ability to coordinate treatment, although most provide some mechanism for a worker to seek a change of physician. WCRI’s survey identifies the initial choice of physician and the procedures for subsequent changes separately—an important distinction when analyzing these states.
2. Employee-Choice Systems
The injured worker generally selects the treating physician.
Examples include:
Alaska • Delaware • Hawaii • Illinois • Louisiana • Maryland • Massachusetts • Montana • Nebraska • New York • Ohio • Oregon • Rhode Island • South Dakota • Washington • West Virginia • Wisconsin • Wyoming
But “employee choice” does not necessarily mean unlimited choice.
Networks, provider authorization, managed-care arrangements, utilization review and requirements that the physician participate in the workers’ compensation system can still affect treatment.
For example, Ohio requires the treating provider to be BWC-certified, while Washington requires the treating physician to be within the workers’ compensation provider network.
A third group gives the employee some choice but controls the universe from which that choice can be made.
Examples include:
Colorado
Employee chooses from a list of four providers.
Georgia
Employee chooses from an employer-provided panel of six.
Pennsylvania
Employee chooses from an employer-provided list during the first 90 days.
Tennessee
Employee chooses from a list of at least three providers.
Virginia
Employee chooses from an employer-provided panel.
Nevada
Employee chooses from the insurer’s treating-provider list.
These systems are particularly important because describing them simply as either “employer choice” or “employee choice” would be inaccurate.
California — Medical Provider Networks
California is one of the clearest examples of a system in which the answer depends upon several preliminary questions:
Does the employer have an MPN?
Did the employee properly predesignate a personal physician?
Is the physician within the MPN?
How long has it been since the injury?
An employee who properly predesignated a physician can have substantially different rights from an employee who did not.
Where an MPN applies, the worker generally chooses within the network and has statutory procedures for changing physicians and obtaining second and third opinions.
WCRI identifies the MPN rules as governing initial physician selection, physician changes and second/third opinions.
Florida — Employer/Carrier Choice
Florida is a classic employer/carrier-directed jurisdiction.
The employer or carrier selects the authorized treating physician, but the injured worker is entitled to a one-time change of physician upon written request.
This distinction is important:
Florida is not a “no-choice” state.
Rather, the carrier initially controls the authorized treating physician, followed by the employee’s statutory one-time change right.
Georgia — Panel of Six
Georgia uses a panel model.
The employer provides a panel of six physicians, and the employee chooses the treating physician from the panel.
The employee is also entitled to one free change from one panel physician to another.
That makes Georgia neither a pure employer-choice nor pure employee-choice jurisdiction.
Pennsylvania — 90-Day Rule
Pennsylvania is another state where the timing matters.
If the employer properly provides a physician list, the employee generally must treat with a provider from that list for the first 90 days.
After 90 days, the employee can select a physician of choice, subject to the statutory notice requirement.
If the employer does not provide the required list, the employee may choose the treating physician.
WCRI identifies this 90-day transition explicitly.
Michigan — 28-Day Employer Control
Michigan provides employer direction for the first 28 days of care.
After that period, the injured worker may select a treating physician.
This makes Michigan particularly important when analyzing whether a particular physician was authorized at a particular point in the claim.
Maine — 10-Day Employer Control
Maine follows a similar—but shorter—transition.
The employer controls medical-provider selection for the first 10 days after injury. After that, the employee can seek his or her own provider.
The employee also has a statutory opportunity to change physicians, subject to the employer/insurer’s ability to contest the change.
New Mexico — Two 60-Day Periods
New Mexico has an unusual structure.
The employer can direct care for the first 60 days, or allow the worker to select a provider. The other party may then have the opportunity to direct care for the next 60 days.
If the employer directed care during the first 60 days, the employee can change physicians after that period.
This is exactly the type of jurisdiction that gets lost in a conventional “employer choice/employee choice” chart.
Utah — Preferred Provider
Utah requires the employee to use the employer’s declared preferred provider when one exists.
If no provider has been declared, the employee receives a choice of provider.
The employee can make one change without employer/insurer approval; subsequent changes require preauthorization.
Texas — Network vs. Non-Network
Texas requires particularly careful analysis.
The provider-choice rules differ depending upon whether the claim is treated through a certified workers’ compensation health-care network.
For network claims, the network establishes the applicable provider-choice rules.
For non-network claims, the employee generally has broader provider choice, subject to Texas Division of Workers’ Compensation requirements concerning changes.
WCRI specifically notes that a network claimant may change treating doctors once without network approval, while subsequent changes generally require network approval.
These concepts should not be combined.
Direction of care asks:
Who decides which doctor treats the worker?
Utilization review asks:
Is the treatment being recommended medically reasonable and necessary under the applicable rules?
An employee can have the right to select a physician while the insurer retains the right to conduct utilization review.
Illinois is a good example: the employee has two free physician choices, but treatment remains subject to utilization review.
California similarly combines provider-network rules with utilization review and treatment guidelines.
A second medical opinion should not automatically be treated as a physician-selection right.
The two questions are different:
Treating physician:
Who provides ongoing authorized treatment?
Second opinion / IME:
Who evaluates the worker or provides an opinion concerning diagnosis, treatment, impairment, causation or another disputed issue?
States impose very different limits on these examinations.
For example:
- Florida generally gives each party one IME per accident.
- Georgia permits an employer an unlimited number of second opinions but gives the employee one under specified circumstances.
- Oregon permits up to three employer/insurer IMEs, subject to additional procedures.
- Virginia generally permits the employer to require one IME per medical specialty per year.
- Ohio permits employees to obtain second opinions without a numerical limit, subject to a reasonableness requirement.
When determining whether a particular medical provider is authorized, a useful checklist is:
1. What state governs the claim?
2. What is the date of injury?
3. Who had initial control of medical-provider selection?
4. Was there a panel?
5. Was there a managed-care organization?
6. Was there a preferred-provider network?
7. Was there a medical-provider network?
8. Did the employee have a predesignated physician?
9. Has the statutory employer-control period expired?
10. Has the employee already exercised a physician change?
11. Was the change approved?
12. Is the new physician within the required network/panel?
13. Was proper notice given?
14. Is the treatment itself authorized?
15. Is utilization review required?
16. Is a second opinion or IME being requested instead of a treating-physician change?
Source & Methodology
The principal cross-jurisdictional source for this chart is the WCRI/IAIABC Workers’ Compensation Laws as of January 1, 2025, Table 3, which specifically examines medical benefits, limitations on medical treatment, initial physician selection, circumstances for changing treating physicians, and limitations on second medical opinions. The participating jurisdictions reviewed the resulting tables as part of WCRI’s quality-assurance process.
WorkersCompensation.com also published a state-by-state survey in February 2026 discussing employer-choice, employee-choice and hybrid physician-selection models.
Because medical-provider rules can change through legislation, regulation, agency guidance and case law, the state statute and administrative rules should be checked before applying a rule to an individual claim.
Last reviewed: September 2026
Disclaimer: This chart is an educational and research reference, not legal advice. The actual right to select or change a treating physician may depend upon the date of injury, employer/carrier status, managed-care or network participation, predesignation, panel requirements, prior physician selections, emergency treatment, authorization requirements and other jurisdiction-specific circumstances.
