Around the States

Who chooses the treating physician, when can the worker change physicians, and how much control does the employer/carrier have?

Current reference: September 2026

Workers' compensation systems take markedly different approaches to medical-provider selection.

Some jurisdictions give the injured worker broad authority to select a treating physician. Others give the employer or insurer primary control. Still others use panel, preferred-provider, managed-care or medical-provider-network systems that divide responsibility between the parties.

For claims professionals, the critical question is not simply “Who chooses the doctor?” It is:

Who controls medical treatment at each stage of the claim?

This chart therefore identifies the initial selection method, the worker's ability to change physicians, and significant network/panel or direction-of-care requirements.

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50-State Chart

State	Initial Choice / Direction of Care	Employee's Ability to Change Physician	Key Direction-of-Care Rule
Alabama	Employer	One change from employer's panel of four, with employer/insurer approval and dissatisfaction with care	Employer-directed system; panel mechanism applies to physician change
Alaska	Employee	One change without restriction; additional changes require written employer/insurer approval	Employer may provide preferred-provider list, but must tell employee use of list is not mandatory
Arizona	Employee, unless self-insured employer directs care	Change with treating-doctor approval, carrier approval, or Industrial Commission approval	Self-insured employers can direct care
Arkansas	Employer / managed care organization	One-time change through Commission; may select within MCO or regular treating physician under statutory conditions	If no MCO, employee may use a physician associated with a certified MCO or regular treating physician
California	Hybrid — MPN/employer control, with predesignation exception	Within MPN, employee may change physicians after initial evaluation; without MPN/predesignation, employee gains broader choice after 30 days	Employee may predesignate personal physician if statutory requirements are satisfied
Colorado	Employee chooses from employer-provided list of four	Several avenues: employer/insurer approval, agency order, treating-physician referral, or insurer failure to respond within 20 days	Rural-area exceptions apply
Connecticut	Employee; must use network if managed-care plan applies	Commission order, insurer approval, or hearing	Managed-care plan can restrict initial provider choice to network
Delaware	Employee, generally from state-provided list	Employee may choose/change physician at any time	Employee may use provider outside list if employer preauthorizes
Florida	Employer/carrier	One-time change upon written request	Carrier generally controls authorized treating physician; employee receives one statutory change
Georgia	Employee chooses from employer panel of at least six or managed-care plan	One free change from one panel physician to another	Panel must satisfy statutory requirements; managed-care arrangements can alter selection
Hawaii	Employee	Additional changes may be requested; generally one change per case absent good/valid reasons	Employee has broad physician-choice rights
Idaho	Employer may direct initial care; if it does not, employee may obtain reasonable care	Change with employer/insurer approval, treating-physician referral, or Industrial Commission petition	Employer direction is permitted but not automatic
Illinois	Employee	Two free choices of physician; additional providers may flow from referrals	Utilization review can restrict treatment even though physician choice is broad
Indiana	Employer	Change requires employer/insurer approval	Employer-directed care
Iowa	Employer	Change requires agency order or employer/insurer/self-insurer approval	Employer-directed care
Kansas	Employer	By agreement or administrative-law-judge order	Physical therapy beyond 21 visits requires authorization
Kentucky	Employee, unless employer has managed-care plan	One change for any reason; later changes require reasonable cause	Managed care is optional; if employer has a plan, employee must use plan providers
Louisiana	Employee	One treating physician in any field/specialty; subsequent same-specialty change generally requires consent; change to another specialty does not require same approval	Employee has an important statutory physician-of-choice right
Maine	Employer for first 10 days; employee thereafter	One change with notice; employer/insurer may contest	Employer loses initial medical control after 10 days
Maryland	Employee	At any time	Broad employee choice
Massachusetts	Employee	One change without consent unless preferred-provider agreement applies; second change requires insurer/self-insurer approval	Preferred-provider agreements can restrict choice
Michigan	Employer for first 28 days; employee thereafter	Employee can change after 28-day employer-control period by notifying employer/carrier	Important statutory transition from employer to employee choice
Minnesota	Employee	Change within 60 days without approval; after 60 days, insurer/self-insurer approval generally required	Certified managed-care plans can require network providers unless employee has documented treatment history with another provider
Mississippi	Employee	Changes may require agency order, insurer approval, or other statutory authorization	Employee initially selects treating physician
Missouri	Employer	Change by ALJ order or employer/insurer approval	Employer-directed model
Montana	Employee initially	Change with employer/insurer approval	After insurer accepts liability, insurer may designate a treating physician and transfer care
Nebraska	Employee	Change by agreement of employee and employer/insurer or court order	Employee has initial choice
Nevada	Employee selects from insurer's treating-provider panel	Within first 90 days and thereafter with written request/insurer approval	Employee chooses from insurer's statutory provider list
New Hampshire	Employee, or within employer MCO if applicable	No specific statutory change provision	Managed-care participation can affect provider selection
New Jersey	Employer	Employer/insurer approval or Workers' Compensation Court order	Employer-directed system
New Mexico	Employer may direct first 60 days; alternatively worker may select and other party can direct next 60 days	If employer directed first 60 days, employee can change after that period	One of the more unusual rotating-control systems
New York	Employee, from Board-authorized providers	Employee may change provider at any time; PPO participants have additional restrictions during initial period	PPO participation can restrict choice; extensive treatment guidelines apply
North Carolina	Employer	Change generally requires Industrial Commission approval	Employee may obtain additional consultations in circumstances permitted by statute
North Dakota	Employee	Change requires Workers' Compensation agency approval	Employer may designate a provider, but employee may retain choice if provider was designated before injury
Ohio	Employee	Employee can change physician at any time	Provider must be BWC-certified
Oklahoma	Employer, except emergency or failure/refusal to provide care	One change upon petition to Workers' Compensation Commission	Employer direction is subject to statutory exceptions
Oregon	Employee, including within MCO when applicable	Two changes by choice; additional changes may be requested	MCO participation can limit provider selection to MCO panel
Pennsylvania	Employee from employer-provided list	Must use list for first 90 days; after 90 days may choose provider, with five-day notice to employer	If employer fails to provide a valid list, employee may choose physician
Rhode Island	Employee	Broad choice; if approved preferred-provider network exists, change must generally remain within network	Network arrangements can restrict physician changes
South Carolina	Employer	Additional changes through agency or employer/insurer approval	Employer has initial control
South Dakota	Employee	Change requires employer/insurer approval	Employee-choice system with controlled changes
Tennessee	Employee chooses from employer list of three or more	Court/insurer approval depending on date of injury and applicable procedure	Panel/list system; post-2014 claims involve Court of Workers' Compensation Claims
Texas	Employee in non-network claims; network claims use network rules	Non-network changes may require DWC approval; network changes follow network procedures	Certified workers' compensation health-care networks substantially change provider-choice rules
Utah	Employer's preferred provider, if declared; otherwise employee gets one choice	One change without approval; additional change requires employer/insurer preauthorization	Preferred-provider designation is central to Utah's system
Vermont	Employer	Employee may elect to change employer's provider at any time by written notice	Employer initially selects, but employee has unusually broad change right
Virginia	Employee chooses from employer-provided panel	Change through Commission, insurer/self-insurer approval, or agency process	Panel system; employer supplies physician choices
Washington	Employee, from workers' compensation network	Employee may change treating physician as long as new physician is in authorized network	Initial emergency/office care can precede network selection
West Virginia	Employee, unless approved managed-care plan applies	Change with insurer/self-insurer approval	Managed health-care plans can require participating providers
Wisconsin	Employee	Employee can change with notice; additional changes may require employer/insurer approval	Broad employee choice
Wyoming	Employee, after any required employer on-site provider	Change requires employer/insurer approval	Employer may require initial treatment from an on-site provider, after which employee selects treating provider

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The Three Major Models

The 50 states can be broadly understood through three medical-provider models.

1. Employer-Directed Care

The employer or insurer has substantial control over the treating physician.

Examples include:

Alabama • Florida • Indiana • Iowa • Missouri • New Jersey • North Carolina • Oklahoma • South Carolina

These states tend to give the employer/carrier greater ability to coordinate treatment, although most provide some mechanism for a worker to seek a change of physician. WCRI's survey identifies the initial choice of physician and the procedures for subsequent changes separately—an important distinction when analyzing these states.

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2. Employee-Choice Systems

The injured worker generally selects the treating physician.

Examples include:

Alaska • Delaware • Hawaii • Illinois • Louisiana • Maryland • Massachusetts • Montana • Nebraska • New York • Ohio • Oregon • Rhode Island • South Dakota • Washington • West Virginia • Wisconsin • Wyoming

But “employee choice” does not necessarily mean unlimited choice.

Networks, provider authorization, managed-care arrangements, utilization review and requirements that the physician participate in the workers' compensation system can still affect treatment.

For example, Ohio requires the treating provider to be BWC-certified, while Washington requires the treating physician to be within the workers' compensation provider network.

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3. Panel / Hybrid Systems

A third group gives the employee some choice but controls the universe from which that choice can be made.

Examples include:

Colorado

Employee chooses from a list of four providers.

Georgia

Employee chooses from an employer-provided panel of six.

Pennsylvania

Employee chooses from an employer-provided list during the first 90 days.

Tennessee

Employee chooses from a list of at least three providers.

Virginia

Employee chooses from an employer-provided panel.

Nevada

Employee chooses from the insurer's treating-provider list.

These systems are particularly important because describing them simply as either “employer choice” or “employee choice” would be inaccurate.

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States With Especially Important Rules

California — Medical Provider Networks

California is one of the clearest examples of a system in which the answer depends upon several preliminary questions:

Does the employer have an MPN?

Did the employee properly predesignate a personal physician?

Is the physician within the MPN?

How long has it been since the injury?

An employee who properly predesignated a physician can have substantially different rights from an employee who did not.

Where an MPN applies, the worker generally chooses within the network and has statutory procedures for changing physicians and obtaining second and third opinions.

WCRI identifies the MPN rules as governing initial physician selection, physician changes and second/third opinions.

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Florida — Employer/Carrier Choice

Florida is a classic employer/carrier-directed jurisdiction.

The employer or carrier selects the authorized treating physician, but the injured worker is entitled to a one-time change of physician upon written request.

This distinction is important:

Florida is not a “no-choice” state.

Rather, the carrier initially controls the authorized treating physician, followed by the employee's statutory one-time change right.

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Georgia — Panel of Six

Georgia uses a panel model.

The employer provides a panel of six physicians, and the employee chooses the treating physician from the panel.

The employee is also entitled to one free change from one panel physician to another.

That makes Georgia neither a pure employer-choice nor pure employee-choice jurisdiction.

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Pennsylvania — 90-Day Rule

Pennsylvania is another state where the timing matters.

If the employer properly provides a physician list, the employee generally must treat with a provider from that list for the first 90 days.

After 90 days, the employee can select a physician of choice, subject to the statutory notice requirement.

If the employer does not provide the required list, the employee may choose the treating physician.

WCRI identifies this 90-day transition explicitly.

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Michigan — 28-Day Employer Control

Michigan provides employer direction for the first 28 days of care.

After that period, the injured worker may select a treating physician.

This makes Michigan particularly important when analyzing whether a particular physician was authorized at a particular point in the claim.

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Maine — 10-Day Employer Control

Maine follows a similar—but shorter—transition.

The employer controls medical-provider selection for the first 10 days after injury. After that, the employee can seek his or her own provider.

The employee also has a statutory opportunity to change physicians, subject to the employer/insurer's ability to contest the change.

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New Mexico — Two 60-Day Periods

New Mexico has an unusual structure.

The employer can direct care for the first 60 days, or allow the worker to select a provider. The other party may then have the opportunity to direct care for the next 60 days.

If the employer directed care during the first 60 days, the employee can change physicians after that period.

This is exactly the type of jurisdiction that gets lost in a conventional “employer choice/employee choice” chart.

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Utah — Preferred Provider

Utah requires the employee to use the employer's declared preferred provider when one exists.

If no provider has been declared, the employee receives a choice of provider.

The employee can make one change without employer/insurer approval; subsequent changes require preauthorization.

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Texas — Network vs. Non-Network

Texas requires particularly careful analysis.

The provider-choice rules differ depending upon whether the claim is treated through a certified workers' compensation health-care network.

For network claims, the network establishes the applicable provider-choice rules.

For non-network claims, the employee generally has broader provider choice, subject to Texas Division of Workers' Compensation requirements concerning changes.

WCRI specifically notes that a network claimant may change treating doctors once without network approval, while subsequent changes generally require network approval.

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Direction of Care vs. Utilization Review

These concepts should not be combined.

Direction of care asks:

Who decides which doctor treats the worker?

Utilization review asks:

Is the treatment being recommended medically reasonable and necessary under the applicable rules?

An employee can have the right to select a physician while the insurer retains the right to conduct utilization review.

Illinois is a good example: the employee has two free physician choices, but treatment remains subject to utilization review.

California similarly combines provider-network rules with utilization review and treatment guidelines.

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Second Opinions and IMEs Are Different

A second medical opinion should not automatically be treated as a physician-selection right.

The two questions are different:

Treating physician:
Who provides ongoing authorized treatment?

Second opinion / IME:
Who evaluates the worker or provides an opinion concerning diagnosis, treatment, impairment, causation or another disputed issue?

States impose very different limits on these examinations.

For example:

• Florida generally gives each party one IME per accident.
• Georgia permits an employer an unlimited number of second opinions but gives the employee one under specified circumstances.
• Oregon permits up to three employer/insurer IMEs, subject to additional procedures.
• Virginia generally permits the employer to require one IME per medical specialty per year.
• Ohio permits employees to obtain second opinions without a numerical limit, subject to a reasonableness requirement.

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What Claims Professionals Should Ask

When determining whether a particular medical provider is authorized, a useful checklist is:

1. What state governs the claim?

2. What is the date of injury?

3. Who had initial control of medical-provider selection?

4. Was there a panel?

5. Was there a managed-care organization?

6. Was there a preferred-provider network?

7. Was there a medical-provider network?

8. Did the employee have a predesignated physician?

9. Has the statutory employer-control period expired?

10. Has the employee already exercised a physician change?

11. Was the change approved?

12. Is the new physician within the required network/panel?

13. Was proper notice given?

14. Is the treatment itself authorized?

15. Is utilization review required?

16. Is a second opinion or IME being requested instead of a treating-physician change?

Source & Methodology

The principal cross-jurisdictional source for this chart is the WCRI/IAIABC Workers' Compensation Laws as of January 1, 2025, Table 3, which specifically examines medical benefits, limitations on medical treatment, initial physician selection, circumstances for changing treating physicians, and limitations on second medical opinions. The participating jurisdictions reviewed the resulting tables as part of WCRI's quality-assurance process.

WorkersCompensation.com also published a state-by-state survey in February 2026 discussing employer-choice, employee-choice and hybrid physician-selection models.

Because medical-provider rules can change through legislation, regulation, agency guidance and case law, the state statute and administrative rules should be checked before applying a rule to an individual claim.

Last reviewed: September 2026

Disclaimer: This chart is an educational and research reference, not legal advice. The actual right to select or change a treating physician may depend upon the date of injury, employer/carrier status, managed-care or network participation, predesignation, panel requirements, prior physician selections, emergency treatment, authorization requirements and other jurisdiction-specific circumstances.