To qualify for workers' compensation benefits, you'll need to choose a health care provider based on the laws applicable to your state of employment, as follows:
- Arizona. You may select your own health care provider for treatment.
- North Carolina. Throughout the life of the claim, you must see one of the health care providers designated by Vanguard.
- Pennsylvania. You must see one of the health care providers designated by Vanguard. However, if you are faced with a medical emergency, you may seek treatment from the closest hospital or health care provider of your choice. Additionally:
- If you need follow-up treatment, you will need to use one of the Vanguard-designated providers. You will have to remain with one or more of the designated providers for at least the first 90 days of treatment for the illness or injury.
- If a provider recommends invasive surgery, you are entitled to a second opinion from a physician of your choice. If your physician's opinion differs and you choose that option, the designated provider will abide by that decision for the first 90 days.
If you refuse reasonable services offered by a designated health care provider, you forfeit all rights to workers' compensation benefits. However, as long as you have followed the above regulations, the provider cannot bill you for any charges not paid by workers' compensation.
Pennsylvania law requires that Vanguard further inform you of the following:
"Any person who knowingly, and with intent to defraud any insurance company/employer or other person, files an application for insurance or statement of claim containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties."