Filing a workers' compensation claim to seek compensation can be overwhelming. It's not easy to deal with the employer and the insurer and convince them that you deserve compensation for injuries suffered in the workplace. There is more to a workers' compensation claim than dealing with the insurance company and your employer. A significant step while filing a workers' compensation claim is choosing the right doctor for all treatments and medical services related to your workers' compensation claim. You have to follow specific processes and rules when selecting a doctor. Your aim should be to choose a doctor who will give you the best medical services and enhance your chances of getting compensation. At The Workers Compensation Lawyer Law Firm, we can help you choose the right medical provider to take care of injuries covered under the workers' compensation in Los Angeles.

Choosing My Preferred Doctor

Are you allowed to choose your preferred doctor after suffering injuries or falling ill at the workplace? According to California's workers' compensation law, you have the freedom to choose your doctor. However, your right to choose a doctor is subject to certain conditions and restrictions. Before you seek medical treatment, you should ensure that the injury suffered qualifies for workers' compensation. Qualifying injuries include injuries sustained at your workplace and injuries sustained while performing off-site work duties. Any complication resulting from the injuries suffered in the workplace will qualify for workers' compensation. 

It's advisable to inform your employer, preferably in writing, about the doctor from who you intend to seek treatment. You should predesignate a doctor and inform your employer every year. You should not wait until you suffer an injury to choose your preferred doctor at the last minute.

Informing your employer about your preferred doctor will also prevent you from choosing a doctor who is not in the approved network. Some insurance companies restrict the doctors that an employee should use in case of an injury. If you qualify to choose your doctor, you simply need to submit your written statement, fill form DWC 9783, or fill the form provided by your employer. The preferred doctor must meet certain specifications. For instance, the doctor must have a valid license.

Seeking Medical Care After an Injury or Work-related Illness

After an accident at the workplace, your goal should be to seek immediate medical attention, especially if the injury is severe. At times, you might be transferred from the workplace to the hospital in an ambulance. In the face of an emergency, you may not have control over which hospital to attend. The chances are that you will end up in a hospital that is close to your workplace. However, depending on the circumstances, you might end up in a hospital designated by you or your employer.

The doctor who treats the injuries you sustain in the workplace will be responsible for your diagnosis and determine whether you suffered the work-related injuries. For instance, after a diagnosis, the doctor may outline that your injury or illness occurred due to poor work conditions. The doctor will recommend the treatment they deem suitable for your injuries. If a doctor cannot handle all or some of your injuries, they will refer you to a specialist. 

Based on the extent of your injuries, a doctor will point out whether you can resume work immediately or you need some time off work. Your doctor will also define your work limits by stating what you can and can't do once you resume work. For instance, a doctor may point out that you should avoid heavy lifting when you resume work, especially after surgery.

It's also your medical doctor's responsibility to advise your employer and the insurance company when you are stable and ready to resume work. The doctor's advice will impact the type of care you receive and also your compensation level. Whether the insurer is willing to compensate you for partial, full, or permanent disability will depend on the doctor's report.

Losing the Right to Your Preferred Doctor

The workers' compensation company or your employer can't force you to see an alternative doctor if you had predesignated a physician earlier. You have a right to stick with your preferred PCP (Primary Care Physician). However, it's worth noting that you can lose this right if you lack health insurance coverage.

You may also lose the right to your preferred doctor if you did not predesignate a doctor earlier. In some instances, you might choose a doctor only for them to decline the designation. In this case, you will lose your right to your preferred doctor. If you don't have the right to a predesignated doctor, you have to work with the doctor that your employer designates.

You could seek treatment from your doctor in certain circumstances and have it covered under workers' compensation insurance even if you had not predesignated the doctor. This happens if your employer fails to inform you about your right to choose your physician. The same case may apply if the employer takes too long to give the workers' compensation claim forms after reporting the work-related injury. In any of the two circumstances, California law allows you to choose your doctor because of your employer's lack of cooperation.

You have to choose an in-network physician if your employer is in a medical provider network (MPN), and you did not predesignate a doctor in advance. In a time of emergency, the law does not restrict you, and you can see any doctor and still be covered under the workers' compensation insurance. Your employer might be in a contract with an HCO (Healthcare Organization). In this case, for the first thirty days of your treatment, your claim's administrator will select a doctor for you.

Your employer has a right to designate a doctor for you if you only suffer minor injuries. However, your rights to choose a doctor are more expensive if you suffer severe injuries.

When You No Longer Trust Your Doctor

What should you do if you feel stuck with a doctor that you are no longer comfortable with or that you no longer trust? It is common for patients filing a workers compensation claim to feel dissatisfied with their initial physicians. You might be uncomfortable with a physician if:

  • They fail to recommend the appropriate treatment.
  • They fail to believe that your injury is work-related
  • They fail to give you ample time off work to allow you to recover from your injuries.

If you feel that you are no longer comfortable with your doctor at some point, you have a right to seek a replacement. You can always seek a second or even a third medical opinion. If you feel dissatisfied with the opinion of your predesignated doctor, you could seek an alternative opinion from physicians in contract with your employer or who are in your employer's network.

However, most people trust their predesignated doctor the most because they already have an existing relationship. If you are being treated by an employer selected doctor and feel like they are favoring the employer, you have a right to seek another doctor's opinion.

How to Change Doctors

What should you do if you are dissatisfied with your current doctor and feel like they can't give you the care you deserve? Perhaps you feel like your compensation is at stake. What steps should you take? The law allows you to seek a second opinion by seeking treatment from an alternative doctor. You don't have to tolerate being with a physician who might lead to a reduction or even denial of workers' compensation benefits.

When changing a doctor, you have to follow some processes and regulations. If you fail to follow the right procedure to change doctors, the insurance company may use this as a reason to withhold payment for your medical treatment. Therefore, if you intend to change your physician, you should only do so with a qualified workers' compensation lawyer. An experienced lawyer will ensure that you follow the right procedures while changing a doctor to avoid compromising your compensation benefits. Before you change doctors, it's essential to know whether your employer has an HCO or an MPN. This will determine the process of changing doctors. If you predesignated your PCP (Primary Care Physician), but you want to change, you are free to do so. However, you will have to use a doctor in your employer's medical network or HCO. Alternatively, you can have the insurance company or your employer choose a doctor for you.

When the Employer Has No MPN or HCO

If your employer does not have an HCO and is not in an MPN, the rules of changing a doctor are as follows. Within the first 30 days, you can switch your physician once. However, you don't get to choose a new doctor. The insurer chooses the doctor. After 30 days, you have a right to choose a doctor, the one you prefer. You can even switch doctors more than once if you feel the need to. There will be no limit on the number of times you can switch doctors. However, it is usually a hassle to switch doctors too many times.

When Your Employer is Within a Medical Provider Network (MPN)

If your employer is within an MPN and you had not predesignated a physician, you have a right to switch physicians two times. However, it's worth noting that while choosing doctors, you must stay within the network. If you still don't feel satisfied with the third in-network physician, you may request an independent medical review on the doctor. A neutral medical professional will evaluate the situation and recommend whether you should get permission to choose an out-of-network physician.

Your Employer Has a Contract With an HCO 

You can only choose a new doctor once if you did not predesignate a doctor and your employer has a contract with a healthcare organization. The healthcare organization will decide on your new doctor, and the doctor must be within the network. If your health insurance is through your employer, you have to wait for up to 90 days to choose a doctor outside the HCO network. However, you have to wait even longer, up to 180 days, if your health insurance is not through your employer. 

How to Choose the Ideal Doctor

You should exercise caution and wisdom while choosing a doctor for a work-related injury. Whether you choose the first doctor or switch doctors, you should ensure that you choose the right doctor. Some of the tips for choosing the right physician for a work injury treatment are as follows:

  • Ensure that the doctor is qualified and has the right expertise to deal with all aspects of your injury
  • You should choose a physician that you can trust and with whom you are comfortable.
  • It's wise to work with a local physician whose office is close to your home or office. This way, you can always visit the doctor at any time.
  • A physician should be honest. Avoid physicians who seem loyal to your employer or the insurance company because they might give a biased opinion regarding your injuries.
  • It's always good to go for a doctor with whom you have a previous relationship. For instance, it's ideal to choose your current or former primary care professional.
  • You should choose a doctor whose services are covered by your health insurance and not just your workers' compensation insurance.
  • A doctor with vast connections is ideal because they can connect you with other medical specialists if necessary.
  • Ensure that your doctor has prior experience dealing with workers' compensation and understands all the relevant paperwork. A doctor must understand that their decisions will impact your workers' compensation.

Choosing the right doctor the first time will save you a lot of hassle later. An experienced workers' compensation lawyer will guide you through the process of selecting the right attorney. However, since you can't predict the future, you may later need to switch doctors when a seemingly reliable doctor proves otherwise. If you need to switch doctors, your lawyer will still guide you through the process. A lawyer will ensure that you adhere to all requirements while choosing or changing doctors to avoid losing compensation. 

Visiting a Doctor During Work Hours

Will you still receive a payment if you miss work to visit a doctor after an injury? Yes, you will receive your pay even if you miss work to seek medical treatment for a work-related injury. After all, an injury or emergency may occur when you least expect it. You should inform your employer about your injury before leaving the workplace to seek treatment. However, if the injury is an emergency, you should seek immediate treatment. You don't have to inform the employer first. 

For a work-related injury, the law states that your employer should pay you for the time you spend seeking medical treatment. This is according to the Fair Labor Standards Act. However, you will only be paid for the time spent at the doctor's office if you would have spent this time working if you hadn't suffered the injury or illness. Even if you have to take some time off work to follow up doctor visits, you are still entitled to full pay. However, the payment may not reflect in your paycheck but will show up as part of your workers' compensation benefits. 

According to California's Labor Code Section 4600 and the federal Fair Labor Standards Act, you are entitled to compensation for:

  • Wait time
  • Travel time
  • Meals
  • Hotels
  • Any expense that you incur while seeking treatment for a work-related injury

Receiving Medical Care

After an injury, you don't have to wait for the approval of your workers' compensation benefits before you begin receiving medical treatment. Such an arrangement would endanger injured workers' lives by denying them the right to immediate medical care. After you file a workers' compensation claim, the insurance company should start catering for your medical expenses immediately. You are entitled to a medical cover of up to $10,000 as the insurance company continues to review your workers' compensation claim. 

After filing a workers' compensation claim, the insurer will have up to 90 days to give you an answer regarding your claim application. By the end of the 90 days, you'll know whether the insurance company will approve or deny your claim. If the insurer doesn't give you a response within 90 days, your claim is approved automatically as outlined under the California Labor Code Section 5402. 

According to the law, as long as you sustained an injury at the job site or while working for your employer away from the job site, the workers' compensation insurance should cover all your medical expenses. The insurance must cover all the necessary medical services to relieve and cure your injury or illness. You should not be subject to a deductible or any out-of-pocket payment for the work-injury medical expenses. The expenses covered by the workers' compensation insurance include: 

  • Doctor fees
  • Prescription medication
  • Hospital bill
  • The necessary medical equipment
  • Sessions with a therapist or chiropractor

Utilization Review

It's essential to choose a doctor who can give you all the medical assistance you require without obstructions. This will reduce the expenses for the insurance company and your employer. However, your doctor is still subject to review, especially when they recommend a particular procedure or operation. Through a utilization review, the insurer must determine whether the recommended treatment is medically necessary to you. 

You don't have much control over workers' compensation because you can't control the insurer that your employer chooses to work with. However, you may be able to control certain aspects depending on your situation. One such aspect is the doctor that you choose to use for your treatment. If the insurance company opposes your physician's choice without a valid reason, you should contact a workers' compensation lawyer. The best way to get the most out of a workers' compensation claim is to choose both your doctor and your attorney wisely. 

Choosing a Specialist Doctor

You can only predesignate a primary care physician. You can't choose a specialist to handle your work-related injury. You can select a primary care physician through designation. You can also select an alternative doctor if you are not happy with your current doctor. One of your doctor's leading roles is to refer you to a specialist depending on the nature of your injury. It's common for people who suffer extreme work-related injuries to require special care. 

When choosing a doctor, you should choose one who is honest and willing to refer you to a specialist if they can't handle your condition. It's crucial to find out if the doctor you choose can make referrals to specialists. You should work with a primary care provider who has existing relationships with specialists. This way, you'll be confident that the doctor will refer you to a specialist who will provide adequate treatment for your injuries if need be. 

Consequences of Choosing the Wrong Doctor?

When you are hurt on the job, the doctor you choose will play an essential role in your workers' comp and recovery. Some of the consequences of choosing an inappropriate doctor are: 

  • Providing you with inadequate treatment
  • Sending you back to work too soon
  • Downplaying your injuries

All these factors might lead to the reduction of your workers' compensation benefits. 

Find a Workers Compensation Lawyer Near Me

Choosing a doctor for your work-related injury is a crucial step that directly impacts your workers' compensation claim. It's essential to find out whether you qualify to choose your preferred physician. It's also crucial to determine whether your employer is within a medical provider network and whether they have a contract with an HCO. This way, you will not compromise your right to workers' compensation medical benefits. You have to comply with various rules and regulations to ensure that workers' compensation covers your medical treatment. This is where an attorney comes in — The Workers Compensation Lawyer Law Firm can guide you through the process of choosing a doctor in Los Angeles, CA. Contact us at 424-501-9228 and speak to one of our lawyers.