Several states have taken steps toward letting injured workers choose their own doctors, a trend experts say can affect costs and outcomes as a key element of medical control shifts away from employers and insurers.
H.B. 1069, introduced Dec. 5 in Indiana, would amend state law to require employers after June 30, 2026, to pay for an “attending physician” selected by the employee, regardless of when the underlying injury or occupational disease occurred.
Washington lawmakers are considering S.B. 5847, introduced Dec. 8, which would explicitly prohibit employers from steering injured workers to a specific provider by making such conduct a violation of good-faith claims-handling laws. Colorado this year enacted H.B. 25-1300, giving injured workers the right to “designate a treating physician,” eliminating the prior requirement that employers offer a limited list of four doctors.
In states where employees have a choice of physicians, claimants tend to report greater satisfaction with their medical care, according to experts. But that flexibility may come at a cost: In such systems, medical and indemnity expenses, particularly for chronic or complex injuries, often rise, especially when injured workers switch providers during a claim, experts say.
States differ widely in their approaches.
At the center of the debate is the tension between autonomy and control. The “biggest controversy” surrounding physician choice centers on patient autonomy, followed closely by concerns about quality, said Kim Radcliffe, Jacksonville, Florida-based senior vice president of product management at Enlyte-owned Apricus. Those two priorities often compete, she said, but autonomy can meaningfully shape recovery, as injured workers tend to be more engaged in the process if they can choose their doctors.
“A lot of outcomes in workers comp have started to really understand that the patient’s perceived disability — their feelings about their employer and their choice and their providers — really does factor into their recovery,” Ms. Radcliffe said. When injured workers feel forced into a limited network, they may think they’re not getting the best care, which can undermine outcomes even if the treatment is sound, she said.
At the same time, Ms. Radcliffe cautioned that unfettered choice can introduce new problems. Physicians without occupational medicine expertise may treat work injuries too broadly, she said, documenting every diagnosis rather than focusing on what is work-related. That can fuel disputes, increase litigation and complicate claims resolution.
“This is your work injury. This is what we’re treating,” she said, noting that providers trained in occupational medicine are more accustomed to drawing those distinctions.
States take widely different approaches to balancing autonomy, according to Jaclyn Schwartz, Rolling Meadows, Illinois-based care networks manager at Gallagher Bassett. In some jurisdictions, employers or insurers direct care entirely, while others allow workers to choose from a panel of physicians, typically a preferred provider network. Still others use hybrid systems, where employers control initial treatment for a defined period before the employee can select a doctor. The hybrid model often works best, as it ensures injured workers understand their options at the time of injury, Ms. Schwartz said.
When workers feel informed, included and supported by claims or resolution managers, results tend to improve, she said. “We see improved satisfaction, reduced litigation, and positive outcomes,” she said. “Overall, the injured worker wants to feel part of the process.”
Provider networks remain popular within the industry for good reason, Ms. Schwartz said. Networks help steer injured workers to credentialed physicians who accept workers compensation patients and agree to contracted rates, supporting both access to care and cost containment. Legislative fee schedules, another trend gaining traction, also have helped control costs, she said.
Colorado’s new law illustrates both the promise and the pitfalls of expanded choice. The statute could delay treatment because of the wide choice patients have, said Douglas Kotarek, Denver-based member of Hall & Evans and head of the law firm’s workers compensation department. Under the new system, injured workers must navigate a list of roughly 1,200 physicians.
“There’s 70 pages of internet search for these doctors,” Mr. Kotarek said. “It’s going to be very difficult for an injured worker who is not used to the system to choose a doctor — and to choose one quickly.”
Those delays, he said, could slow access to care, postpone return-to-work timelines, lengthen disability periods and encourage doctor-shopping aimed at securing more favorable disability opinions, potentially increasing litigation.
Some industry leaders agree that a middle-ground approach offers the best path forward. Selecting a doctor is pivotal because it can shape recovery trajectories and claim outcomes, according to Josephine Copeland, New Castle, Delaware-based senior vice president of product design and strategy at Sedgwick. While employee choice enhances autonomy, it can also introduce inconsistent expertise and delays, she said in an email.
“A middle-ground approach — allowing employees to choose from approved networks — aims to blend clinical quality with patient choice,” Ms. Copeland wrote. Increasingly, organizations are using data analytics to evaluate and score providers based on outcomes, identifying high-performing physicians regardless of who technically selects them.
Offering choice empowers injured workers and can boost engagement and satisfaction, according to Ms. Copeland. Pairing that autonomy with data-driven guidance allows employers and insurers to promote quality care, manage costs and support better recoveries.
“The ongoing challenge,” she wrote, “is balancing state regulations, efficient care delivery, and respect for employee preference — all crucial for better recoveries and claim resolutions.”
This article was first published in Business Insurance
