State of delaware – division of industrial affairs – workers’ compensation – health care payment system – provider certification

In accordance with the provisions of 19 Del.C. §2322(D), certification is required for a health care provider to provide treatment to an employee, pursuant to Delaware’s Workers’ Compensation Statute, without the requirement that the health care provider first pre-authorize each health care procedure, office visit or health care service to be provided to the employee with the employer if self-insured, or the employer’s insurance carrier. Pursuant to 19 Del.C. §2322B and F, for purposes of the Certification requirements of §2322D, "health care provider in an inpatient hospital setting" specifically includes physicians, chiropractors and physical therapists providing treatment to an injured worker during his/her period of inpatient hospitalization; all other personnel employed by a hospital providing treatment to an injured worker during his/her period of inpatient or outpatient hospitalization are excluded from the Certification requirements of this Subsection.


With regard to any hospital facility providing inpatient and/or outpatient services, to be Certified in accordance with the provisions of §2322D so that pre-authorization from the employer or insurance carrier for the employer is not required for each health care procedure, office visit or health care service provided to an injured employee, the person completing and signing the Health Care Provider Application for Certification on behalf of the hospital shall have the authority to do so and must attest to and be responsible for the completion of all of the requirements set forth on such Application. Services provided by an emergency department of a hospital pursuant to §2322B shall not be subject to the requirement of Certification. The provisions of §2322(D) shall apply to all treatments to employees provided after the effective date of the rule/regulation provided by this subsection and regardless of the date of injury. A health care provider shall be certified only upon meeting the following minimum certification requirements:

• Have no felony convictions in any jurisdiction, under a federal-controlled substance act or for an act involving dishonesty, fraud or misrepresentation. A felony conviction in any jurisdiction under a federal-controlled substance act or for an act involving dishonesty, fraud or misrepresentation shall be considered to be inconsistent with certification;

• Complete state-approved continuing education courses in workers’ compensation every two (2) years from the last date the health care provider renewed his or her Delaware professional license. Out of state health care providers, who are not licensed in Delaware, must complete State-approved continuing education courses in workers’ compensation every two (2) years from the date of the out of state provider’s initial certification. A listing of continuing education courses in workers’ compensation care approved by the State of Delaware, Department of Labor, Office of Workers’ Compensation, will be posted on the Office of Workers’ Compensation website. To maintain certification, the health care provider must provide written notification to the Office of Workers’ Compensation of compliance with the continuing education course requirement noted above, setting forth the name of the course(s) completed and the date of completion;

Notwithstanding the provisions of §2322(D), any health care provider may provide services during one office visit, or other single instance of treatment, without first having obtained prior authorization from the employer if self-insured, or the employer’s insurance carrier, and receive reimbursement for reasonable and necessary services directly related to the employee’s injury or condition at the health care provider’s usual and customary fee, or the maximum allowable fee pursuant to the workers’ compensation health care payment system adopted pursuant to 19 Del.C. §2322(B), whichever is less. The provisions of this subsection, §2322(D), are limited to the occasion of the employee’s first contact with any health care provider for treatment of the injury, and further limited to instances when the -2- health care provider believes in good faith, after inquiry, that the injury or occupational disease was suffered in the course of the employee’s employment. The provisions of this subsection, §2322(D), shall apply to all treatments to injured employees provided after the effective date of this subsection, and regardless of the date of injury.

The Workers’ Compensation Oversight Panel, in accordance with 19 Del. C. §2322D, established a certification process for health care providers who treat Delaware’s injured workers. This link provides a list of those health care providers who are certified to date. Each day the Office of Workers’ Compensation receives additional applications and updated information; consequently, the list cannot be all inclusive and will regularly change to reflect newly certified providers. If you do not see a particular health care provider on this list and you need to know if that provider is certified to treat workers’ compensation patients, we recommend you check directly with the provider.