Do I Get to Pick My Own Doctor for My Workers’ Compensation Claim?
If you’ve been injured on the job in California, one of the first questions you may have is where to go to get medical treatment. Can you choose which doctor you go to, or does your employer (or their insurance carrier) decide who you see? The answer depends on several factors, including whether you have predesignated a physician and the rules set by your employer’s workers’ compensation insurance provider.
Below, we explain your rights when it comes to selecting a doctor for your workers’ compensation claim in California. For help with a denied claim or other issues in Orange County or the Inland Empire, contact Invictus Law, P.C., to speak with a board-certified specialist in workers’ compensation serving Southern California.
Understanding Medical Provider Networks (MPNs)
In California, most employers use a Medical Provider Network (MPN), which is a group of doctors approved by the employer’s workers’ compensation insurance company. If your employer has an MPN, you are typically required to choose a doctor from within that network for your treatment. However, if you are dissatisfied with your assigned doctor, you have the right to switch to another doctor within the MPN.
If your employer does not have an MPN, you may be treated by a physician chosen by the claims administrator for the first 30 days following your injury. After 30 days, you can select a different provider if you are dissatisfied with the treatment you are receiving.
Can I Choose My Own Doctor from the Start?
Yes, but only if you have predesignated a doctor before your work injury occurred. Predesignation means that you informed your employer in writing, before your injury, that you want your personal physician to treat you in the event of a work-related injury. To qualify for predesignation:
- You must have health coverage for non-work-related injuries through your employer’s group health plan.
- Your chosen doctor must agree to treat you for work-related injuries.
- You must have provided your employer with written notification of your predesignation before your injury occurred.
If you meet these criteria, you have the right to be treated by your predesignated doctor instead of one from the employer’s MPN.
What If I’m Not Satisfied with My Assigned Doctor?
If you are unhappy with your initial treating physician, you can request a change. If your employer has an MPN, you can select another doctor within the network. If there is no MPN, you may be able to switch doctors after 30 days, as long as the new provider is authorized by the claims administrator.
If you feel that your medical treatment is inadequate, or that your treating physician is not acting in your best interest, you have the right to seek a second opinion or change doctors. However, navigating this process can be challenging, and having a knowledgeable workers’ compensation attorney on your side can make a significant difference.
Why Choosing the Right Doctor Matters
The doctor treating your work injury plays a crucial role in your workers’ compensation claim. Your physician will determine:
- The severity of your injury
- The necessary medical treatments
- Whether you can return to work
- Any permanent disability benefits you may be entitled to
An insurance-approved doctor might not always have your best interests in mind, as they are often working within cost-containment guidelines set by the employer’s insurance company. If you are concerned about receiving the best possible care, consulting with a workers’ compensation attorney can help protect your rights and ensure you receive the medical attention you deserve.
Get Help With Your Workers’ Compensation Claim
At Invictus Law, P.C., we focus exclusively on helping injured workers in Orange County and the Inland Empire. If you have concerns about your medical treatment or your workers’ compensation benefits, we are here to guide you through the process and advocate for your rights. Contact us today at our offices in Orange and Ontario for a free consultation to learn more about your legal options.
