Your primary care doctor in a workers compensation scenario plays a huge role in determining the final outcome of the entire case. Your employer’s workers’ compensation insurance carrier will want to know every single detail about the injury and will have to rely on the final documents from a qualified physician to make their decision whether to accept or deny your claim.
Now this begs the question, who gets to select your treating doctor in a workers compensation case, and is it possible to change doctors if, for some reason or another, you’re not satisfied with your initial doctor?
The quick answer is that both you and workers’ compensation insurance company have some say in who is your treating doctor.
Do I Get to Choose My Doctor From the Start?
The state of California allows injured or ill workers to choose their own primary care physician from the start, although there are a few conditions that must be met before this is possible.
- First of all, the affected employee must already have health care coverage for medical treatment unrelated to work injuries.
- Secondly the employee must have given their employer a written notice about the pre-designated physician before the injury/illness occurs.
- Thirdly, the doctor/physician in question must have agreed in advance to provide treatment for work-related injuries or illnesses.
Pre-designation
So yes, you can choose your doctor from the start in a workers compensation case if you already fulfill the conditions above. Regarding the point about pre-designation, what you have to do is use the form provided by the California Department of Workers’ Compensation (DWC Form 9783) to specify a qualified medical group as your pre-designated physician.
Failure to predesignate a physician before injuries or illnesses occur usually means that the employer in question will not be able to choose the initial physician they get to work with.
From a practical perspective not many family doctors will agree to treat a workers’ compensation injury because of all the red tape involved. Additionally, most non workers compensation doctors do not know how to write reports that can be used at trail to help your case.
Medical Provider Network (MPN)
There are also situations where your employer’s insurance carrier has an existing agreement with a medical provider network, which is a network of medical practitioners and hospitals.
In this case you can only select a physician of your choice from the network. This is a very common situation.
Exceptions
Even in cases where employees did not provide predesignated physicians, or where the insurance carrier already has an existing medical provider network, injured workers can still work with physicians of their choice under the following conditions:
- It is an emergency medical situation
- The employer has failed to provide legally required notices and information
Scenario 1: No Existing Contract with an MPN
In a situation where your employer and their insurance carrier have no existing contract with a MPN, then you’re free to switch to a new treating doctor once during the initial 30 days of reporting the injury/illness.
The caveat here is that, again, this must be a physician whose name you have already predesignated with the appropriate form. Your employer’s insurance carrier will not allow you to select an entirely new physician. Instead, you will have to switch to whichever one they end up choosing for you at that point (if they do so in a 5-day period).
You can also request a new doctor of your choice after the first 30 days. Switching of physicians in a workers compensation case must be reasonable according to California labor law. (Cal. Labor Code §§ 4600(c), 4601 (2020).)
Scenario 2: An Existing Contract with an MPN
In cases where your employer and their insurance carrier have an existing contract with a Medical Provider Network (MPN), you are free to switch treating doctors as much as you like, so long as it is not considered unreasonable abuse. The only caveat here is that the doctors you switch too must also be a part of the network specified by the insurance carrier.
This also applies even in cases where your initial doctor was pre-designated by you.
Getting Help
If you happen to be unsatisfied with the doctor in your workers compensation case, or disagree with their opinions regarding your condition, there is absolutely nothing wrong with switching to a better alternative.
Of course, understanding and navigating the technicalities involved in selecting and changing your doctor may be an incredible task for many, and that is why we always recommend getting help from an experienced, qualified practitioner.
The experienced attorneys at The Morris Law Group can help you successfully navigate the task of switching practitioners and even suggest more competent ones.
Talk to us today.