Key Differences in Delaware's Medical Treatment Rules
Delaware mandates that all medical care for a workers' compensation claim be provided by an approved provider and that the treating physician submit a treatment plan within 10 days of the injury. The state also requires a second opinion for any treatment that costs over $1,000 or involves surgery, and it limits the number of visits to the same provider unless medically necessary.
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Required Provider and Initial Evaluation
Employers must report an injury to the Delaware Division of Workers' Compensation within 30 days. The injured worker then selects a physician from the state's approved list, or the employer designates one. The initial evaluation must include a detailed diagnosis, proposed treatment plan, and estimated duration. Failure to provide this plan within the 10‑day window can trigger a denial or a request for supplemental information.
Treatment Plan and Documentation Requirements
All treatment plans must specify:
- Type of treatment (medication, physical therapy, surgery)
- Frequency of visits and expected duration
- Reassessment dates
- Estimated costs and justification for any expensive procedures
Physicians must submit the plan electronically and keep a copy on file for at least 12 months. Workers must follow the plan and report any changes or complications promptly.
Second Opinion and Cost‑Control Measures
When a treatment exceeds $1,000, a second opinion from an independent provider is required before the claim proceeds. The second opinion must be obtained within 15 days of the initial recommendation. This process helps prevent unnecessary surgeries and controls state medical expenditures.
Dispute Resolution and Appeals
If a claimant disagrees with the treatment plan or the denial of a service, they can file an appeal within 30 days. The appeal process involves a hearing before a workers' compensation judge, where both parties present medical evidence and expert testimony.
| Aspect | Requirement | Timing |
|---|---|---|
| Initial Evaluation | Physician diagnosis and plan | Within 10 days of injury |
| Second Opinion | Independent review for costly treatments | Within 15 days of recommendation |
| Appeal Filing | Dispute resolution | Within 30 days of denial |