Directing Care and Chain of Referral

Self-insured employers and insurance companies often set up physician networks in advance of individual cases so that there are no surprises concerning who is going to treat and evaluate an injured worker.  Setting up a network of medical providers is a contractual issue which is legal under Colorado workers’ compensation law as long as the communication by the self-insured employer or insurance carrier regarding to whom the primary treating physician can refer cases has been established prior to the onset of an individual case.  Requesting or demanding an authorized treating physician to make a referral to a particular medical provider in an individual case may constitute “dictating to” that physician, which is impermissible by law.  (See “DICTATING TO A PHYSICAN” elsewhere in this Glossary).  Once an employer or self-insured employer chooses the primary physician, every referral made by that treating physician, as well as every referral made by the referrals, is considered to be authorized.