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July 08, 2025
The Challenges Injured Workers in Central Pennsylvania Face When Searching For Proper Medical Care
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As large healthcare networks have expanded into Central Pennsylvania, many people living in the areas covered by those networks have likely benefited from their presence. With improved quality control and standardized care, greater access to experienced and specialized physicians and nurses, and a tightly integrated network of caregivers who can more effectively coordinate with each other, these healthcare networks can improve health outcomes for people who rarely had access to best-in-class medical care.
But there’s one group of people who don’t appear to have benefitted much from large healthcare networks expanding into Central Pennsylvania: injured workers. We at Pond Lehocky Giordano are seeing many injured workers in Central Pennsylvania struggle to find treatment options at large healthcare networks when their workers’ compensation claims have been denied or when those claims go into litigation. They struggle because many networks are not able to treat injured workers if their workers’ compensation claims have been denied, or cannot advocate for them against an insurance carrier that typically holds the purse strings when deciding whether a physician gets paid for the services they provide.
Injured workers’ inability to find treatment options prevents them from promptly receiving medical care so they can heal and support their families the way they did before they suffered their injuries. As these networks grow larger, it’s not a stretch to imagine a world where injured workers in Central Pennsylvania have to travel far distances, or rely on a few independent physicians, to receive the treatment they desperately need.
Injured workers’ path to medical care
After a worker is injured on the job, the Pennsylvania Workers’ Compensation Act requires them to, if they want their medical treatment to be paid for, treat for up to 90 days with one of several medical providers pre-selected by their employer, so long as the employer fulfilled several prerequisites, such as providing written notice about employees’ obligations to treat with one of these panel physicians.
That said, most employers do not satisfy these requirements, so their injured workers can treat with a physician of their choosing. Additionally, if an injured worker’s compensation claim is denied during those 90 days, they too are free to seek treatment with a physician of their choosing. But that’s where the problems begin.
Injured workers have three options when their workers’ compensation claim is denied.
First, they can pay for their medical care and treatments out of pocket. Few can afford to do so.
Second, they can claim their injuries were not work-related in order to secure insurance coverage from their primary medical insurer. (Insurers providing personal medical insurance to individuals and their families do not cover work-related injuries.) This would likely constitute insurance fraud, thus it is not a feasible option. In addition, it would also result in a healthcare lien being asserted by the payor/insurance carrier against either the injured worker or the workers’ compensation insurance carrier if the injured worker later decided to pursue workers’ compensation benefits.
Third, the injured worker can find a physician willing to treat them despite the denial of their workers’ compensation claim. Those physicians would choose to do so without a guarantee that their bills would ever be paid. Before healthcare became big business, including the emergence of large healthcare networks, this option was a feasible one because there were legions of physicians willing to do so. Today, fewer physicians are willing to take a chance treating injured workers whose claims have been denied. To be clear, some still do. They should be lauded for doing so.
Some healthcare networks urge their doctors not to treat injured workers whose workers’ compensation claims have been denied
When more local physicians owned their practices and knew their patients personally or were a degree or two of separation away from most of them, they were often willing to treat an injured worker despite the uncertainty surrounding whether the physician would be paid for their services. The physician, as the owner of their practice, could decide to prioritize doing no harm over maximizing their profits and hope that the worker would prevail in their workers’ compensation litigation so that the physician’s bills would be paid.
I am not describing the way things were in the early 1900s. Nor am I describing the era of Norman Rockwell’s Saturday Evening Post covers. I am talking about a time as recent as Barack Obama’s second term in the White House.
But over the past decade or so, as healthcare networks swallowed independent medical practices and exerted more control over the operations of those practices, the third option is quickly becoming no option at all. Physicians have told my colleagues and I that executives and senior management at healthcare networks are urging them not to treat injured workers whose workers’ compensation insurance claims have been denied. The networks do not want to risk waiting a year or more to receive payment for their physicians’ services, or risk nonpayment, by taking on an injured worker who may not ultimately prevail in their workers’ compensation claim.
Some healthcare networks are also urging their doctors to not advocate for injured workers whose workers’ compensation claims are being litigated
We also hear from physicians that even when injured workers’ workers’ compensation claims have not been denied, executives and senior management at healthcare networks are urging physicians not to advocate for them in two principal ways.
First, physicians are being asked not to testify in court or in an administrative hearing. There’s a concern from management that their testimony could come back to haunt the network in some way. Unfortunately, many times, an injured worker’s treating physician’s testimony can be the difference between the worker winning or losing the dispute over their workers’ compensation claim.
Second, physicians are being asked to not order or not perform medical treatment that has not been authorized or pre-authorized by the worker’s employer’s workers’ compensation insurer. This is despite Pennsylvania law stating that insurers cannot require pre-authorization in order to be compelled to pay for a treatment or procedure. Even when an injured worker’s treating physician had diagnosed the injury as one requiring surgery, we understand that network management will push network-affiliated surgeons not to operate on the worker because the insurer has not already authorized the surgery.
Injured workers in Central Pennsylvania are forced to turn to a limited number of independent physicians
Healthcare networks are putting their affiliated physicians in a tough position with these edicts. We know from speaking with these physicians that they want to treat injured workers and get them back on their feet. Unfortunately, today’s business and economic realities mean these physicians are limited in their ability to do so.
However, despite healthcare networks proliferating in Central Pennsylvania, there are still some physicians in the region with active practices who are not affiliated with these networks. Given the struggles injured workers in Central Pennsylvania encounter finding physicians who will treat them in the face of a denied workers’ compensation claim, or merely a litigated one, workers’ compensation claimants’ firms operating in Central Pennsylvania owe it to their clients to develop networks of trusted independent physicians they can refer their clients to.
These physicians, unencumbered by healthcare network executives’ and management’s focus on the bottom line, may be the only ones across far distances in Central Pennsylvania who can help those workers heal, get back on their feet, and get back to work so they can resume supporting their families.
Workers’ compensation claimants’ firms who build local referral networks of independent physicians in rural areas like Central Pennsylvania can expect their attorneys to be questioned by judges and opposing counsel on why it seems the same relatively few physicians are treating those firms’ clients. Opposing counsel, and even neutrals during mediation or arbitration, may attempt to discredit those physicians because they tend to frequently treat a law firm’s clients. But the explanation for why they do so is as simple as it is concerning: Too many area physicians are affiliated with healthcare networks that tie their hands when treating injured workers, which prevents those workers from getting the medical treatment they need—and deserve—to help them heal from their work injuries.
Although many network-affiliated physicians would like to help these workers, given the state of the healthcare business in Central Pennsylvania, unless these physicians can successfully push back against their networks’ executives and management, independent physicians will be the only ones injured workers and their counsel regularly turn to for treatment.
Ryan D. Tilley is a handling attorney at Pond Lehocky Giordano Inc., the largest workers’ compensation and social security disability law firm in Pennsylvania, and one of the largest in the U.S. He can be reached at rtilley@pondlehocky.com.
Reprinted with permission from the July 3, 2025 edition of The Legal Intelligencer © 2025 ALM Media Properties, LLC. All rights reserved. Further duplication without permission is prohibited, contact 877-257-3382 or reprints@alm.com.
