123.1 Payment for medical benefits and services pursuant to Section 2303 of the Act shall only be made, where an employee has complied with §§ 104 and 115 of this chapter and the claim has been accepted by the Program. After a claim is accepted, the Program may reimburse an employee for any out-of-pocket expense paid by the employee for any necessary treatment directly related to the workplace injury.

123.2 In order for the Program to pay for the services provided by a treating physician, the physician must be a member of the Program's panel of treating physicians, except as follows:

(a) An injured employee may, when the employee is first injured, select a non-panel physician to provide medical services, appliances, and supplies if the employee is unable to make an appointment with a panel physician due to the urgency of the need for treatment.

(b) If there is a need for immediate medical treatment and, due to the nature of an injury, and the injured claimant is unable to contact a physician, the injured claimant may seek treatment at an emergency care facility. Notice of the provision of emergency care shall be provided to the Program no later than thirty (30) days after the care is rendered.

123.3 If a claimant decides to receive treatment from a non-panel physician after the Program provides the claimant with a list of panel physicians, the claimant is not entitled to reimbursement for the cost of services provided by the non-panel physician.

123.4 Once a panel treating physician is selected to provide treatment under the Act, a claimant shall not change to another physician or hospital without authorization of the Program, except in an emergency.

123.5 If the claimant is not satisfied with the medical care provided by a panel physician, claimant shall complete and return Form M3, with justification to the Program. The Program shall permit a change where the Program finds the change to be in the best interest of the claimant.

SOURCE: Final Rulemaking published at 28 DCR 2307 (May 22, 1981); as amended by Emergency and Proposed Rulemaking published at 57 DCR 9540 (October 8, 2010)[EXPIRED]; as amended by Final Rulemaking published at 57 DCR 12224, 12229 (December 24, 2010); as amended by Final Rulemaking published at 59 DCR 8766, 8771 (July 27, 2012); as amended by Final Rulemaking published at 64 DCR 6325 (July 7, 2017).