When you are injured in a workplace accident, getting the right medical treatment is crucial for your recovery. One of the most common questions injured workers have is whether they can choose their own doctor for treatment under California’s workers’ compensation system. The answer depends on several factors, including whether you have predesignated a doctor before your injury and the specific rules of your employer’s workers’ compensation insurance plan. This article explains your rights and options when it comes to selecting a doctor after a workplace injury in California.
1. The Role of the Employer’s Medical Provider Network (MPN)
In California, most employers have a Medical Provider Network (MPN) that includes a list of doctors and healthcare providers approved by the workers’ compensation insurance carrier. If your employer has an MPN, you are generally required to select a doctor from this network for your initial treatment.
- Initial Treatment: After reporting your injury, your employer or their insurance carrier will refer you to a doctor within the MPN for your initial evaluation and treatment. You must see a doctor within this network unless you have predesignated your own physician before the injury occurred.
- Switching Doctors: If you are not satisfied with the care you are receiving, you may be able to switch to another doctor within the MPN. Your employer or insurance carrier should provide you with a list of available providers.
2. Predesignating Your Doctor
If you prefer to receive treatment from your personal physician in the event of a workplace injury, you have the option to predesignate your doctor. Predesignating means you choose your primary care physician (PCP) to treat you for work-related injuries before an injury occurs.
- Eligibility for Predesignation: To predesignate your doctor, you must meet certain criteria:
- Your Doctor’s Agreement: Your chosen doctor must agree in writing to be predesignated and treat you for work-related injuries.
- Group Health Insurance: You must have group health insurance coverage through your employer, and your predesignated doctor must be your regular physician.
- Written Notice: You must provide your employer with written notice of your predesignated doctor before you are injured.
- Advantages of Predesignation: If you have predesignated your doctor, you can seek treatment from your chosen physician immediately after a workplace injury, without having to go through the MPN.
3. What If I’m Dissatisfied with My MPN Doctor?
If you are not satisfied with the treatment you are receiving from a doctor within the MPN, you have the right to request a change. Here’s how you can proceed:
- Request a Change: You can request to switch to another doctor within the MPN. Your employer or insurance carrier is required to provide you with a list of available doctors within the network.
- Second Opinion: If you disagree with the diagnosis or treatment plan of your MPN doctor, you can request a second opinion from another physician within the MPN.
- Independent Medical Review (IMR): If you are still not satisfied after a second opinion, you may request an Independent Medical Review (IMR). An IMR is conducted by a neutral third-party physician who reviews your case and makes a recommendation.
4. Exceptions to the MPN Requirement
There are certain situations where you may be allowed to seek treatment from a doctor outside of the MPN, even if you have not predesignated a physician:
- Emergency Situations: If you require emergency medical treatment due to a workplace injury, you can seek care from the nearest medical facility, regardless of whether the provider is within the MPN. Once your condition stabilizes, you may be required to transfer your care to an MPN provider.
- Unavailability of MPN Providers: If there are no doctors within the MPN available to treat your specific injury or if the MPN does not include specialists needed for your care, you may be allowed to seek treatment outside the network.
- Employer Non-Compliance: If your employer fails to inform you of your rights regarding the MPN or does not provide you with access to an MPN, you may be allowed to choose your own doctor outside the network.
5. How Laguna Law Firm Can Help
Navigating the workers’ compensation process and understanding your rights to medical treatment can be challenging, especially when dealing with an injury. At Laguna Law Firm, our experienced workers’ compensation attorneys are here to help you:
- Understand Your Rights: We will explain your rights regarding medical treatment under California workers’ compensation law, including your options for choosing a doctor.
- File a Claim: Our team will assist you in filing your workers’ compensation claim, ensuring that all necessary documentation is submitted accurately and on time.
- Advocate for Your Care: If you encounter difficulties with your MPN doctor or need help obtaining the treatment you deserve, we will advocate on your behalf to ensure you receive proper medical care.
6. Conclusion
Your right to choose a doctor after a workplace injury in California depends on whether you have predesignated a physician and the specific rules of your employer’s Medical Provider Network (MPN). While the system generally requires you to see an MPN doctor, there are options and exceptions that may allow you to receive care from your preferred physician. If you’ve been injured at work and need help understanding your rights or navigating the workers’ compensation process, contact Laguna Law Firm today. Our dedicated attorneys are here to help you secure the medical treatment and benefits you need for your recovery.
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