Choosing Your Doctor for a California Work Injury
An experienced workers’ compensation lawyer can protect your rights
When you’re hurt on the job, you need to get immediate medical treatment for your injuries, both to help you physically recover and to help you access the workers’ compensation benefits you are entitled to receive by law. Your choice of doctor is important; you want a doctor who will give you the right treatment, make appropriate referrals and recommendations, and help establish the full extent of your injuries to protect your rights.
California law gives the injured worker the power to change doctors if you’re not fully satisfied with your care, but there are strict rules that apply to making that switch. The workers’ compensation attorneys at McLaughlin & Sanchez can help you navigate this system.
How you choose the initial treating doctor
The initial treating doctor is the physician who will diagnose your injury and assess whether it’s connected to your job. Seeing this doctor is a critical moment in the workers’ compensation process. Your doctor will recommend treatment, take you off work or recommend restricted job duties if medically necessary, and refer you to a specialist if necessary.
Many injured workers would like to see their personal doctor to make this initial assessment. In California, you can do this, but only if the following criteria are met:
- Your employer provides regular health insurance coverage.
- You “predesignated” your personal doctor to treat you – that is, you gave your employer written notice that you wanted your personal physician to treat future work injuries.
Otherwise, you must generally begin treatment with a doctor chosen by the insurance company, or within the network established by the insurance company.
How to change your treating doctor
If you aren’t satisfied with the care you are receiving, you can go through the appropriate process to switch to another doctor. The process depends on whether the insurance company has a medical provider network (MPN), that is, a group of providers set up by the insurance company and approved by the Division of Workers’ Compensation to treat work injuries; a health care organization (HCO), an organization certified by DWC and contracted by the insurance company to provide medical services to injured workers; or neither. It also depends on whether you predesignated your personal physician.
If you predesignated and there is an MPN or HCO, then you are free to switch from your predesignated doctor to another doctor in the MPN or HCO at any time.
If you predesignated and there is no MPN or HCO, then you can switch doctors once within the first 30 days, but the insurance company will usually select the new doctor. After 30 days, you are free to switch to the doctor of your choosing as long as you notify the insurance company of the change.
If you didn’t predesignate and there is an MPN, then you have to stay within the MPN, but you are free to switch to a doctor of your choice within the MPN at any time after your initial examination.
If you didn’t predesignate and there is an HCO, then you can request to change doctors at any time, but the HCO will assign the new doctor. You can see a doctor outside the HCO after 90 days if you don’t have regular employer-provided health coverage or 180 days if you do have regular employer-provided health coverage.
If you didn’t predesignate and there is no MPN or HCO, then if you request to switch doctors within the first 30 days, the insurance company chooses the new doctor. After 30 days, you are free to switch to a doctor of your choice as long as you notify the insurance company.
How a lawyer can help you get the medical care you need
Insurance companies can be notoriously difficult about allowing workers to exercise their right to change doctors. They can be even more difficult when it comes to actually paying for the medical treatment your doctor recommends – even if it’s a doctor who they picked in the first place. It can be an exceptionally frustrating process, but you don’t have to go through it alone. A workers’ compensation attorney who knows the rules and knows the system can fight to ensure that you get the treatment you need to get better.
If you need help choosing your doctor or getting your medical treatment approved, give us a call or contact us online. We’ll listen to your story and explain your legal rights. Don’t go it alone; get an experienced workers’ compensation attorney on your side today.