Many state workers’ compensation laws allow employers to establish physician panels for workers’ compensation injuries. Pennsylvania, Virginia, West Virginia, Tennessee, North Carolina and Indiana allow employers to designate physician panels from which injured workers must seek care for work related injuries.
- In Pennsylvania, employees must sign an Employee’s Acknowledgement of Physician Panel form (Spanish version). This form must be signed twice; at the time of hire and as soon as possible after the injury occurs. This form records that the employer informed the employee of his/her rights under the Workers’ Compensation Act, and that the employee understood those rights.
- In other states ― Wisconsin, Illinois, Maryland and the District of Columbia ― voluntary panels are offered from which employees may, but are not required, to seek treatment for work injuries.
Erie Insurance will supply you with recommended medical providers for the physician panels. If you’re already working with a physician, we’ll consider your recommendations as well.
To request a physician panel, fill out this form. Please specify your policy number on the request.
Once you have received your physician panel, ERIE recommends that you send a letter to each provider on the list advising them that they have been selected for your workers’ compensation physician panel. A Provider Sample Letter can be sent on your letterhead notifying the providers of their designation.
For more information, contact a local Erie Insurance Agent.
*ERIE's business insurance coverage is not available in Kentucky.