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Workers’ Comp Doctor: Can I Choose One? How Do I Select One?

Group of doctors in clinic

When you are injured on the job in California, you are entitled to workers’ compensation coverage for your medical expenses. However, actually getting the benefits you are owed can be a complicated process, and there are many traps for the unwary that can lead to limited benefits being paid. In some states, workers are limited to doctors covered by their workplace health plan; seeing the wrong doctor can lead to treatments not being covered. In other states, workers are afforded more choice. How does physician choice work under California’s workers’ compensation scheme? Read on for an answer, and if you’ve been hurt on the job in Southern California, reach out to a seasoned Riverside workers’ compensation lawyer for assistance.

Can You Choose Your Doctor After a Workplace Injury? It Depends.

Selecting your initial treating doctor after a workplace injury can have a huge impact both on the quality of your treatment and the processing of your workers’ compensation claim. Ideally, you would be able to choose your own personal doctor, who you know provides you quality treatment and who is already in your corner, rather than a doctor in the insurance provider’s pocket.

In California, workers have the right to choose their personal physician or qualified medical group as their treating doctor for a worker, but ONLY IF the following applies:

  • The employee has health care coverage for medical treatment unrelated to work injuries;
  • The employee has already given their employer prior written notice (called “predesignation”) of their choice to have their personal physician treat them for future workplace injuries; and
  • The chosen doctor has agreed in advance to treat the employee’s work-related injuries or illnesses.

If you are hurt on the job and you have not predesignated your personal physician or medical group, then you will likely be unable to choose your personal doctor as your initial treating physician. Your employer or the workers’ comp insurance company will provide you with either a specific doctor or a list of doctors within their established medical provider network (MPN).

If you require emergency medical treatment, or if your employer fails to provide you with proper legal notices concerning your workers’ comp rights, you might be able to get out of the rule and see your own doctor even absent predesignation.

Can You Change Your Doctor After Your Initial Treatment? It Depends.

Assuming you did not predesignate your physician and you are treated initially by a doctor chosen by the insurance provider, you might be able to change doctors after your initial visit. Typically, employers and/or insurance providers have an MPN that they work with. If your employer or the insurer contracts with an MPN, you can typically switch to another doctor within the MPN after your initial treatment. Your employer or the insurer must provide you with instructions as to how to switch doctors. Workers are generally not permitted to switch to a doctor outside the MPN.

Some employers or insurers contract with specific health care organizations (HCO). Employers with HCO deals must give employees the choice about whether or not to enroll in the HCO when they are first hired. If you are enrolled in an HCO through your employer, and you are treated by a doctor within the HCO initially, you may be able to switch to a doctor outside the HCO within a certain period of time after your initial reported injury or illness date.

If you are not being treated in an MPN or HCO, and you did not predesignate, you may be able to switch doctors after your initial treatment. But, your claims administrator is probably allowed to pick your new doctor as well.

Keep in mind that the MPN rule only applies to accepted claims. In denied cases, MPN treatment is not authorized, and the injured worker will be treated on a lien basis with non-MPN physicians.

A benefit of hiring a workers’ comp attorney on an admitted claim is the attorney’s knowledge of designating the best doctors within the MPN. The MPN list is wide-ranging from very conservative doctors that do not offer quality treatment to liberal doctors that give an ear to worker’s injuries and provide the necessary treatment.

Get Your Questions Answered and Your Benefits Won

For help getting benefits after an on-the-job injury or workplace illness, call Ochoa & Calderon to discuss your case with a knowledgeable and dedicated California workers’ comp lawyer. Call 951-901-4444 in Riverside or 844-401-0750 toll-free throughout Southern California.

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