Under California workers’ compensation regulations, injured California workers in most cases are not treated by a physician they choose. Rather, they must be treated by a doctor designated by their employer’s insurance company. In some cases it’s possible to obtain treatment from a doctor outside the insurer’s designated treatment network, but you have to name (or “pre-designate”) that physician before you are injured.
You can pre-designate your doctor if:
- Your employer provides group health coverage
- The doctor has seen you previously and has your medical records
- Before the injury, the doctor agrees to treat you for work injuries/illnesses
- Before the injury, you notify your employer that you want this doctor, and you provide the doctor’s name and address
If you do not pre-designate a physician prior to your injury, you will be treated by a doctor in the insurance company’s medical provider network (MPN). However, after your first visit you may change doctors within the network. A medical provider network is an association or group of healthcare providers set up by an insurer (or by a self-insured employer) and approved by the California Division of Workers Compensation (DWC) to treat workers injured on the job.
Each MPN must include doctors who specialize in work-related injuries and doctors with general medical expertise. MPNs must meet access-to-care standards for common work-related illnesses and injuries and must adhere to all treatment guidelines set forth by the DWC. MPNs must offer an opportunity for second and third opinions if the injured worker disagrees with the initial diagnosis or treatment. If a disagreement remains after a second and third opinion, an injured worker may request an independent medical review.
If you’ve filed for workers’ compensation, these decisions should be made with the advice of an experienced California workers’ compensation attorney. There are ways to obtain treatment from a physician outside an insurance company’s designated medical provider network. A good workers’ compensation lawyer will be thoroughly familiar with the regulations regarding pre-designation and will work diligently to help you get the medical care and services you need. In California, if you’ve been injured at work or if you’re suffering a work-related illness, speak to an experienced California workers’ compensation attorney immediately.