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.
What Injured Workers Should Know About Treatment Options
Each Medical Provider Network (MPN) must include doctors who specialize in work-related injuries as well as physicians with general medical expertise. MPNs are required to meet access-to-care standards for common workplace injuries and illnesses and must follow all treatment guidelines established by the Division of Workers’ Compensation (DWC).
MPNs must also provide injured workers with the opportunity to seek second and third opinions if they disagree with an initial diagnosis or treatment plan. If disagreements continue after those opinions, the worker may request an independent medical review.
If you have filed a workers’ compensation claim, these decisions should be made with the guidance of an experienced California workers’ compensation attorney. There may be options for receiving treatment outside of the insurance company’s designated MPN.
A skilled workers’ compensation attorney can explain the rules regarding predesignation, protect your rights, and help you obtain the medical care you need. If you have been injured at work or are suffering from a work-related illness in California, contact an experienced California workers’ compensation attorney as soon as possible.