Employer Choice in Workers’ Comp – a State-by-State Survey

Introduction 

In workers’ compensation cases, the selection of a treating physician significantly impacts both the injured worker’s recovery and costs borne by employers and workers’ compensation payers. Some states allow employees to choose their own physicians, while others require them to seek treatment from employer-selected providers and/or panels.i In the United States, approximately half of the states allow injured workers to choose their treating physician after an industrial accident.ii The two main models are known colloquially as “panel” and “choice”.iii In this white paper, we survey the U.S. landscape and summarize the pros and cons of each method. While both approaches have their advantages, we believe that employer-directed panel jurisdictions provide the best outcomes in terms of return to work, cost savings, and employee satisfaction.iv   

State-by-State Overview of Physician Selection Rights 

Again, the authority to choose a treating physician in workers’ compensation varies by state.v Some states grant employees full autonomy, others allow employers to dictate care, and a few adopt a hybrid model that balances both interests. Understanding these distinctions is crucial for both employers and employees as they navigate the complexities of workers’ compensation systems.  

Employee-Choice States 

In these states, injured workers have the right to select their treating physician without restrictions. Having the ability to choose a physician can lead to greater trust and comfort in the medical care received, which may contribute to better treatment adherence. This choice can also allow employees to continue treatment with a provider who is already familiar with their medical history, leading to more personalized care. However, employees may struggle to find a physician who is knowledgeable about workers’ compensation processes and reporting requirements. This challenge could lead to delays in treatment approval and reimbursement issues for both the employee and employer. Balanced against this is the opportunity for claimants to “doctor shop” or seek treatment from multiple care providers until they obtain the desired treatment plan.  

• Examples of employee choice states include: Alaska, Connecticut, Delaware, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Mississippi, Montana, Nebraska, New Hampshire, New York, North Dakota, Oregon, Rhode Island, South Dakota, Washington, West Virginia, Wisconsin, Wyoming, and the District of Columbia.vi 

Employer-Choice States 

Employers in these states have the authority to designate the treating physician for the injured worker.vii This approach ensures that medical providers are familiar with occupational injuries and are aligned with best practices in returning employees to work. Additionally, employer-directed care helps streamline administrative processes by reducing unnecessary medical disputes and coordinating treatment with company policies.viii While this can reduce costs and streamline care, some employees may feel that employer-selected doctors do not have their best interests in mind. Employees may worry about biased medical opinions that favor a quicker return to work rather than a full recovery. 

• Examples of employer choice states include: Alabama, Arkansas, Idaho, Indiana, Iowa, Kansas, Kentucky, Maine, Michigan, Missouri, New Jersey, Oklahoma, South Carolina, South Dakota, Tennessee, and Vermont.ix 

Hybrid or Conditional States: A Middle Ground 

A hybrid state in workers’ compensation physician selection is just what is sounds like – jurisdictions in which neither the employer nor the employee has absolute control.x This approach seeks to balance employers’ financial concerns with employees’ rights and comfort.xi By implementing hybrid systems, these states seek a compromise that provides cost savings while still affording employees some choice in their medical treatment. 

• Examples of hybrid or conditional-choice states include California, Pennsylvania, Georgia, Texas, Arizona, Colorado, and Minnesota.xii 

Key Features of Hybrid States 

1. Predesignation Option: Employees may predesignate a doctor before an injury occurs, allowing them to bypass employer-directed care if injured.xiii This option provides employees with peace of mind, knowing they will receive care from a trusted provider. Failure to predesignate may result in the default employer-directed process. 

2. Employer-Directed Initial Treatment: In these jurisdictions, employees must see an employer-selected doctor for a set period (e.g., 30 days) before choosing their own provider.xiv After the mandatory period, employees can seek alternative opinions or specialized care if necessary.xv  

3. Restricted Employee Choice: Herein, employees may select a doctor but only from an employer-provided panel. This limits employee autonomy but ensures that physicians are familiar with occupational injury treatment.  

4. Managed Care Networks (MCNs): Some states require treatment within an approved provider network.xvi This ensures consistency in treatment protocols and cost containment for employers.  

5. State-Mandated Provider Lists: In these states, treatment must be received from state-approved medical professionals. This regulation standardizes care quality across workers’ compensation cases.  

A Few Unique Outliers with Hybrid Systems 

Texas 
Texas remains a unique non-subscriber jurisdiction, although in recent years, employers have had greater control over medical treatment in practice.xvii More and more big companies use certified workers’ compensation health care networks recognized by the Texas Department of Insurance.xviii These networks let businesses send injured workers to network doctors and closely monitor them.  

California 
California is still considered a hybrid state, but the increasing use of Medical Provider Networks (MPNs) has given employers far more influence over medical treatment.xix Administrative regulations and utilization review processes have made the system mostly employer-directed.xx  
 
Florida 
Recent changes in Florida law have made it more employer-friendly. Employers and carriers have significant freedom to choose the doctors who will treat them and to move care within approved provider networks.xxi  
 
New York 
New York still gives injured workers the legal right to choose their own doctor, but in practice, that right has become more difficult to exercise.xxii More use of preferred provider groups and greater enforcement of Medical Treatment Guidelines have made it harder for employees to choose their own doctors. New York is still officially an employee-choice state, but employers and carriers now have a lot more say over treatment choices. 
 
Pennsylvania 
In Pennsylvania, workers who are hurt may be required to see panel doctors for the first 90 days after the incident.xxiii After that, employees can choose their own doctor. This strategy lets employees choose while also giving businesses real early influence over medical management and coordinating their return to work. 
 
Georgia 
Georgia still has a limited-choice panel system, which means that companies must maintain a panel of doctors that injured workers can choose as their treating provider.xxiv Stricter enforcement of panel composition and posting standards has strengthened employer control while still allowing employees some options.  

Summary 

The choice of treating physician in workers’ compensation cases has significant implications for cost containment, medical quality, and return-to-work outcomes. Employer-directed physician selection results in lower medical costs, faster recovery times, and reduced fraud, while employee-choice states often experience higher medical expenses and longer claim durations.xxv Hybrid models attempt to balance both interests by implementing predesignation options, employer-approved panels, and mandatory care periods. Employers who understand and effectively manage these regulations can significantly reduce workers’ compensation expenses while ensuring injured employees receive appropriate medical care.xxvi  

About the author 

Dennis Sponer serves as fractional general counsel and advisor to several healthcare companies and VC firms through his consultancy, SRX Advisors. He is licensed as an attorney in California and Nevada and is a senior advisor to Connected Capital, a London-based UK FCA-regulated advisory firm. He is a thought leader in the legal, health-tech, biotech, pharmaceutical and startup worlds.  

Before founding his consultancy, Sponer co-founded ScripNet, a uniquely designed pharmacy benefit management (PBM) company. After serving as in-house counsel for one of Las Vegas’s largest healthcare conglomerates, he devised ScripNet as a payer-based technological solution to the pharmaceutical payment and remittance challenge. Sponer sold ScripNet to Optum Healthcare Solutions in 2012. His latest venture, HSARx, was a consumer-facing pharmacy benefit manager serving health savings account owners. He sold HSARx to SwiftScript in October of 2023.  

Sponer obtained his Juris Doctorate from Brigham Young University and his Master of Laws in Taxation (L.L.M.) from the University of San Diego. He earned his MBA through TRIUM, a program jointly administered by New York University’s Stern School of Business, the London School of Economics, and HEC Paris. 

Sponer can be reached at dsponer@srxadvisors.com. 

Endnotes 

1. Taylor, K., Mueller, L., Blink, C., McKinney, W., Silverman, W., Das, R., & ACOEM Work Group on Workers’ Compensation. (2020). Workers’ Compensation Elements in Different Jurisdictions in the United States. ACOEM Guidance Statement, 6. https://doi.org/10.1097/JOM.002047 

2. Voisin, M. (2024, May 8). Which states let injured workers choose their own doctors? Disability Approval Guide. https://www.disabilityapprovalguide.com/workers-compensation/injured-workers-choose-doctors/ 

3. Dpt, S. M. (2019, July 31). Workers’ Comp Referrals: Panel vs Choice State. BTE. https://www.btetechnologies.com/therapyspark/workers-comp-referrals-panel-vs-choice-state/ 

4. WCRI: Medical fee schedules play big role in shaping price changes during inflationary period in state workers’ compensation systems | WCRI – Workers Compensation Research Institute. (n.d.). https://www.wcrinet.org/news/news_info/wcri-medical-fee-schedules-play-big-role-in-shaping-price-changes-during-inflationary-period-in-state-workers-compensation-systems 

5. Ametros Financial. (2024, December 16). Can I seek medical treatment with a doctor of my own choosing? – Ametros. Ametros. https://ametros.com/faqs/workers-compensation/can-i-seek-medical-treatment-with-a-doctor-of-my-own-choosing/ 

6. 2022 WCRI Annual Report now online | WCRI – Workers Compensation Research Institute. (n.d.). https://www.wcrinet.org/news/2022-wcri-annual-report-now-online-1 

7. Id. 

8. Mannion, A. (2023, June 6). What are the key drivers of workers’ comp costs? This NCCI report reveals the answers. Risk & Insurance. https://riskandinsurance.com/what-are-the-key-drivers-of-workers-comp-costs-this-ncci-report-reveals-the-answers/ 

9. Workers’ compensation trends. (n.d.). The Hartford. https://www.thehartford.com/workers-compensation/industry-trends 

10. Information, D. O. W. C.-. I. W., & California, S. O. (n.d.). DWC Medical Provider Network. https://www.dir.ca.gov/dwc/mpn/dwc_mpn_main.html 

11. Division of Workers’ Compensation. (2023). 2023 RESULTS & ACCOMPLISHMENTS REPORT. In Department of Financial Services. https://myfloridacfo.com/docs-sf/workers-compensation-libraries/workers-comp-documents/reports/dwc-annual-reports/2023-ed-dwc-annual-summary.pdf 

12. Workers’ compensation insurance by state. (n.d.). The Hartford. https://www.thehartford.com/workers-compensation/states 

13. Compensation, S. B. O. W. (2024, September 26). Board forms. State Board of Workers’ Compensation. https://sbwc.georgia.gov/publications-and-forms/forms/board-forms 

14. Medical providers. (n.d.). https://dir.nv.gov/WCS/Medical_Providers/ 

15. Workers’ compensation. (n.d.). Department of Labor and Industry | Commonwealth of Pennsylvania. https://www.pa.gov/agencies/dli/programs-services/workers-compensation.html 

16. Medical Provider Network: What it is & its role in workers’ compensation | Direct PT/DX. (2025, February 18). Direct PT/DX. https://directptdx.com/what-is-a-medical-provider-network-and-what-is-its-role-in-workers-compensation/ 

17. nonsubscriber workers compensation plan. (n.d.). https://www.irmi.com/term/insurance-definitions/nonsubscriber-workers-compensation-plan 

18. List of certified workers’ compensation health care networks. (n.d.). Texas Department of Insurance. https://www.tdi.texas.gov/wc/wcnet/wcnetworks.html 

19. Enlyte. (2026, February 2). A closer look at California MPNs. https://www.enlyte.com/insights/podcast/case-management/closer-look-california-mpns 

20. California Department of Industrial Relations. (n.d.-a). DWC FAQs on UR for claims administrators. https://www.dir.ca.gov/dwc/utilizationreview/ur_faq.htm 

21. Workers compensation insurance. (n.d.). Property and Casualty. https://floir.gov/property-casualty/workers-compensation-insurance 

22. Work Injury Source. (2023, July 6). The role of artificial intelligence in workplace safety: Who is responsible when you get injured on the job? Work Injury Source. https://workinjurysource.com/what-you-need-to-know/state-workers-compensation-resources/can-you-see-your-own-doctor-on-workers-comp-the-law-in-all-50-states/ 

23. Physicians list defined. (n.d.). Department of Labor and Industry | Commonwealth of Pennsylvania. https://www.pa.gov/agencies/dli/programs-services/workers-compensation/wc-health-care-services-review/ire-physician-listing/physicians-list-defined 

24. Compensation, S. B. O. W. (2026, February 6). Employer information. State Board of Workers’ Compensation. https://sbwc.georgia.gov/employer-information 

25. Neumark, D., Barth, P. S., & Victor, R. A. (2007). The impact of provider choice on workers’ compensation costs and outcomes. ILR Review, 61(1), 121–142. https://doi.org/10.1177/001979390706100107 

26. 2023 Workers Compensation financial results update. (n.d.). NCCI Holdings Inc. https://www.ncci.com/Articles/Pages/Insights-2023-WorkersComp-Financial-Results-UPD.aspx