Receiving quality medical attention should be a priority for anybody who sustains an injury or suffers an illness on the job. Your treatng physician plays a critical role in how your workers' compensation claim will turn out and the compensation benefits you’ll receive. The state of California has comprehensive rules on choosing a treating doctor. You want to talk to an experienced workers’ compensation attorney so you don’t make a decision that will negatively impact your chances of receiving workers’ compensation benefits.

At The Workers Compensation Lawyer Law Firm, we have extensive knowledge of California law on choosing a doctor after a work-related injury. We’ll guide you through the provisions of the law and help you make an informed decision. Other than that, we’ll help you fight and ensure you receive just compensation for your injuries/illness. Reach out to us any time for a consultation if you’ve sustained an injury/illness on the job in LA County.

Can I Choose The Doctor Who Treats Me?

Most people ask if they can choose their treating doctor after a work-related injury in California. The answer to this question is yes. California law provides that you can visit a physician of your choice to treat a job-related injury but under given conditions.

Per the California Department of Industrial Relation’s Workers’ Compensation Guidebook for Injured Workers, every worker has the right to be compensated for any injury they suffer on the job. You will be compensated if you sustain an injury due to a single event or constant exposure to workplace risks that ultimately cause injuries. In given cases, your employer could also be responsible for injuries arising due to stress. Under California law, if you report being injured after being fired, your employer isn't responsible for those injuries.

Circumstances Under Which to Choose Your Treating Physician

In the state of California, you can go to the doctor of your choice for treatment after a job-related injury/illness, but only when:

  • You have predesignated

  • Your physician has agreed beforehand to treat your on-the-job illnesses or injuries.

  • There are dishonest practices by your employer.

  1. What's Predesignation?

Predesignation refers to the process of notifying your employer that you prefer using your personal physician or doctor of your choice for work-related illnesses or injuries. You must do this before the injury/ illness, and you should do it in writing. The letter must have the address and name of your preferred doctor.

The Predesignation Process and Limitations

You must notify your employer before you sustain the injury and in writing. We have two ways of doing so. The first one is by writing your own statement, and the second way is by filling a form your employer will provide you with.

Most employers usually contract health care organizations (HCO) to address their employees' injuries. In this case, you will use a different form provided by the Division of Workers' Compensation (DWC Form 1194). This form requires you to provide much more information, like your name, employers' name, predesignation statement (the statement should include your preferred doctor’s name, address, and phone number), the date, and your signature. Additionally, you must complete this form within thirty days of your employment. In given cases, the form can be completed yearly.

You could also predesignate a professional medical group. In this case, you will have to complete a different form availed by the Division of Workers' Compensation, known as DWC Form 9783. You can download this form online. The rules here are a little different if the employer or their insurance company has contracted an HCO to address work-related illness and injuries for the workers. If that is true, you could predesignate your own acupuncturist, chiropractor, or physician. Your employer should provide you with the correct predesignation form when you are hired and annually after that.

To Predesignate a Medical Group, They Must Meet Given Conditions

The medical group you predesignate must have licensed medical doctors and doctors of osteopathic medicine. Their healthcare delivery should be specialized and primary. Finally, the groups should primarily treat medical conditions that aren't work-related.

Unluckily, not every worker can predesignate. To qualify for predesignation, you must have health care insurance coverage for illnesses or conditions that aren't work-related. If you don't have health care insurance coverage for medical conditions that aren't job-related, you can't predesignate, meaning you can't choose your own physician when injured on the job.

If you did not predesignate your own treatment physician, you might not be capable of choosing the initial doctor you go to for treatment. If the employer or their insurer has established an MPN (medical provider network), you will generally be required to select a physician in the network. But there are exceptions, which includes when:

  • Your employer has not given you the legally required information or notices, or

  • You need emergency medical attention

Likewise, if the employer's insurance company has contracted an HCO, you will typically be treated within the HCO right after suffering an injury. And if there is no HCO or MPN contract, the claims administrator has the legal right to pick your treating physician for the first thirty days of your injury then you can go to a doctor of your choice after that.

What’s an MPN?

An MPN is a group of physicians approved by a workers’ compensation insurance provider to treat injured workers.

The Reason for MPN

An MPN is an insurance company’s effort to control the cost of medical treatment in the workers' compensation system. The insurers may try to exclude given doctors from its network, believing the physician requests excessive medical treatment or gives so much permanent disability.

However, since an MPN should be large enough to treat all injured workers, limiting physicians is usually impractical. Thus, the insurance provider will first send an injured worker to a physician who works in their favor then hope the worker doesn't take further action.

  1. Your Doctor Should've Agreed Beforehand to Treat Your Work-Related Injuries

Another requirement to choose your own doctor to treat your work-related injury is that the doctor you select should've agreed to treat you for any injury you may sustain on the job before it occurs. We recommend that the agreement between you and your doctor should be in writing. Also, you must have an established relationship with the physician before predesignation. The physician should know your medical history and have your medical records.

  1. Dishonest Practices

If you didn't predesignate your physician and sustain a job-related injury, you might go straight to your trusted doctor if your employer conducted illegal business practices. For instance, you have to be informed of your legal right to predesignate a physician and be provided with a workers' compensation form right after your employer learns of your injury. There also has to be sufficient workers' compensation right info available to you at work. If any of these conditions aren't met, the state's law allows you to visit your own physician first since there's reason to believe your employer will mishandle your treatment.

Changing Your Doctor

You must be comfortable with the doctor treating you, both as far as the care you are receiving is concerned and all the decisions they’re making regarding your capability to resume or continue working. If you strongly feel uncomfortable or disagree with the doctor’s decisions, you can switch doctors. The process of doing so is based on whether or not there’s an HCO or MPN.

If There Is No HCO or MPN

Where your employer/their insurance company has not contracted an HCO or established an MPN, you can switch to your own treating physician after the first thirty days of reporting your illness or injury are over. However, unless you have provided your employer with the name of your personal acupuncturist or chiropractor before your injury, the claims administrator might generally select the new physician (if they do so in five days of your request). After thirty days, you can choose your new treating physician within a reasonable distance from your home. You could switch physicians again if it is practical.

If the Employer Has a Healthcare Organization

If you have been undergoing treatment with a physician within a Healthcare Organization, you could change at least one time to another physician within the Healthcare Organization. You may change to another health care provider (including an acupuncturist or chiropractor) after a 180-day waiting period if you have health insurance provided by your employer. If you are not covered, you’ll have to wait for ninety days to switch doctors. The new doctor has to be based within a reasonable distance from your home. Similar rules for changing physicians apply if you have been going to your pre-designated doctor for treatment, but your employer for their insurance company has contracted an HCO.

If the Employer Has Established an MPN

If the employer has established an MPN, you may request to change physicians at least two times. However, the second and third physicians have to be from the MPN. This is the case even if you have been visiting your predesignated personal doctor for treatment. If you're still not content with the third doctor’s opinion, you may apply for an independent medical review with an unbiased medical professional. Based on the review results, you could then be capable of choosing a physician outside the MPN.

If your work environment is risky, making you susceptible to injuries, you want to understand the workers' compensation law basics. Additionally, workers' compensation statutes are subject to regular amendments and changes. The expertise of a workers' compensation attorney will also help you navigate this process. As a worker, you might not understand all the provisions of the law, which could result in your claim being denied. Understanding workers' compensation law helps you act within its confines, helping you secure fair compensation for your work-related injuries.

Independent Medical Review in Detail

As we mentioned, if you still dispute a treatment or diagnosis after switching doctors for the third time, you can seek an independent medical review. The independent physician will continue following the same standard as in the utilization review.

The independent review physician will assess all your medical records to do with your treatment. If you request, they may also examine you, carry out any mandatory diagnostic exams and give their report in thirty days.

The independent medical review and utilization review are entirely different. Under the utilization review, the process addresses whether medical treatment is ideal. The MPN matter is related to whether the physician is the right person to perform the treatment.

The independent doctor sends the report to the administrative director, who then notifies you. The opinion of the independent medical review physician is the final say. If they approve a previously denied treatment, any doctor can treat you, either out of or in the Medical Provider Network. The physician must comply with the treatment guidelines.

No other exams can be used to solve a treatment or diagnosis problem between you and your treating physician.

It's unlikely that you'll go through the process of receiving the second opinion and beyond because of the delay in receiving treatment. If you want a second opinion, you'll likely need to wait thirty days for the second opinion report to be issued from the time you start the process. It might be significantly lengthier than that.

Seeing a physician for a third opinion and independent medical review could take several months and might not be reasonable when you have a severe health issue.

How to Select a Treating Physician

When you have the chance to select your own doctor to treat your work-related illness or injury, whether the initial physician or are considering switching doctors, you should weigh your options carefully. You should research physicians available in your community and consider their:

  • Conversancy with your kind of injury

  • Area of specialization (for instance, neurology or orthopedics)

  • Level of expertise and experience

  • Availability for appointments

  • Proximity to your home or workplace. The physician's office should be reasonably near your workplace and home

  • Willingness to agree to the state's workers' compensation medical fee schedule

  • Understanding of workers' compensation claims and willingness to advocate on your behalf

  • Honesty. Your doctor shouldn't be loyal to your employer or your employer's insurance company.

  • Knowledge of handling workers' compensation or related paperwork. Your doctor should understand how their decisions will affect your compensation

The physician's personality is also critical. You need to trust your physician and feel comfortable around them while discussing your concerns and conditions with them. Choosing a doctor with whom you have an already established relationship is also an added advantage.

In essence, select the appropriate physician at the beginning, and it will save you headaches later. However, nobody can foretell the future. If you must switch doctors, your workers' compensation attorney may help you navigate the process so you'll meet all the requirements and your claim will not be denied.

The Role of the Treating Physician in Your Workers' Compensation Case

Necessary and reasonable medical care is among your most valuable workers' compensation benefits. And as we mentioned, it is essential to select a physician who won't only treat your injuries or illness but also advocate on your behalf in your workers' compensation case. That is because your treating doctor's medical opinions and findings are the most crucial elements to prove your workers' compensation case.

If your physician is not willing to assist you with your claim, you should consider finding the one that will. A skilled workers' compensation lawyer can help you with where to look.

Your treating physician's opinion carries significant weight in your workers' compensation claim. Unlike a physician who will examine you only once, a treating physician monitors your recovery process over time, making them understand your injuries better. It also makes them know what you require for your treatment, your physical limitations, and the possibility of fully recovering.

Your physician will make critical decisions as far as your case is concerned, which will directly impact your benefits and recovery. These decisions include:

  • Diagnosing and treating your condition— your doctor will have to diagnose you to obtain workers' compensation benefits. They'll also have to direct all your medical treatment, deciding whether or not you need medication or physical therapy, for instance.

  • Deciding your work restrictions— your treating physician decides whether you should have time off work, which allows you to recover and collect partial wage benefits (known as temporary disability benefits). The doctor also decides when you are capable of returning to work. If they decide to send you to work too soon or with no work restrictions, you may hurt yourself further.

  • Referring you to a specialist— your physician will be required to sign off on any referrals to a specialist, for instance, an orthopedist or surgeon. Your physician's willingness to listen to your opinion and give you the care and treatment you require is essential.

  • Providing proof for your claim— your doctor will prepare medical records at each appointment, which will serve as proof in your compensation case. Consistent and careful documentation of your injuries, treatment, and recovery can result in fewer disputes with the insurance provider. Your physician may also have to testify in your favor during disposition or at the workers' compensation hearing.

  • Determining your extent of permanent disability—after reaching maximum medical improvement, that is, when your medical condition is stable and won't improve further, your physician will evaluate you to determine whether you have any permanent limitations. Their conclusions will then be used to determine how much compensation you will receive for permanent disability.

Doctor Visitation During Work Time

No good worker wants to skip work. Also, you may be concerned about whether you'll be paid or not if you go to your doctor during working hours. Nobody plans to sustain an injury, suffer an illness, or be in any other medical emergency while on the job. These things still happen nevertheless, and the moment they do, you’re not supposed to waste any time but seek the necessary medical attention right away. You also shouldn't waste any time in bringing a workers' compensation claim.

If you randomly missed work or went to see your dentist, you would not be paid for the lost working hours. If you miss work due to a non-job-related reason or when it wasn't an emergency and could've gone when you're off duty, do not expect that you'll be compensated for the hours you missed work. However, work-related injuries or illnesses are different. You can't face any consequences for going to the doctor for an on-the-job injury, illness, or emergency health care.

When it comes to on-the-job injuries, the state's law dictates that your employer compensate you for the period you spent undergoing treatment because otherwise, you would've been working. However, you won't be compensated for the time you spent at the physician's office if that day was not part of your scheduled workday.

Additionally, if you must see your physician in follow-up check-ups later, and your employer or their insurance provider necessitates those visits, you'll be compensated if the visits make you miss more hours of work. However, the compensation won't reflect in your pay. Instead, it'll be part of your workers' compensation benefits, particularly counted as a day's worth of temporary disability indemnity.

Both California Labor Code Section 4600 and the federal Fair Labor Standards Act require that you are compensated for physician appointments under the circumstances mentioned above. Your employer or their insurer cannot just deny you pay just because you weren't working. You also should be compensated for meals, wait time, travel time, and hotel expenses (if they apply) as part of the specialist or doctor's appointments. Since it's challenging to understand precisely how the workers' compensation system worked, you want to seek help from an expert lawyer so you won't be denied the benefits that rightfully belong to you.

Find a Competent Workers' Compensation Attorney Near Me

If you have problems regarding medical matters in your workers' compensation case, whether you are unsatisfied with the care you have been receiving, disagree with your physician's opinions concerning your work limitations or diagnosis, or the insurance provider is dragging its feet on approving recommended treatment, you want to talk to a workers' compensation attorney.

At The Workers Compensation Lawyer Law Firm, we are knowledgeable about workers' compensation law. We may be able to help you navigate the intricate process of choosing or switching doctors and being approved for required medical care. We may also recommend an expert treating physician who is conversant with the complex workers' compensation system. Call us at 424-501-9228 if you’ve suffered a job-related injury or illness in Los Angeles, and we’ll be glad to help.