California Workers' Compensation FAQ
Can I choose my own doctor for workers comp in California?
As a Los Angeles workers’ compensation lawyer, I sometimes hear from clients who are not happy with their doctors or medical treatment. They want to know if they can switch to another doctor. The answer is “yes,” but, like all other aspects of workers’ compensation in California, there are a lot of restrictions.
As an injured worker, your right to switch depends on whether:
- You are being treated in a Medical Provider Network (MPN).
- You are being treated in a Health Care Organization (HCO).
- You are not being treated in either, but did not pre-designate your own doctor.
- You are being treated by your own pre-designated doctor.
- You Are Being Treated in an MPN
After your first medical examination, you may switch to another doctor in the MPN. Your employer or its insurer is required to give you a list of doctors in its MPN. If you dispute the doctor’s diagnosis or treatment plan, you can request a second and a third opinion from other doctors in the MPN. If you are still dissatisfied with your diagnosis or treatment, you can request an independent medical review (IMR). If the IMR decides in your favor, you can see a doctor outside the MPN.
Are Being Treated in Health Care Organization (HCO)?
After your first medical examination, you may switch to another doctor in the HCO at least once. If you have health insurance through your employer, you may switch to a doctor outside the HCO 180 days after your illness or injury is reported to your employer. If you do not have employer-provided health insurance, you can switch to a doctor outside the HCO 90 days after your illness or injury is reported to your employer.
What happens if you are not being treated in either a Medical Provider Network (MPN) or a Health Care Organization (HCO) and you did not pre-designate your doctor?
In this case, you can switch to a new doctor once during the first 30 days after your illness or injury is reported to your employer. The insurance company has the right to choose the doctor but must do so within five working days after you make the request (10 if the request is made by mail). If the insurance company misses the deadline, you can choose your own doctor.
After 30 days, you may switch to a doctor of your choice if your employer or insurer still has not established an MPN.
What if you are being treated by your own pre-designated doctor?
Your Employer/Insurer Does Not Have Either an MPN or HCO: The rules for switching are the same as described above under You Are Not Being Treated in Either an MPN or HCO and Did not Pre-designate Your Doctor.
Your Employer/Insurer Has an MPN: Your pre-designated doctor can refer you to other doctors outside the MPN for specialized treatment or a consultation. Otherwise, you can switch to a new doctor within the MPN.
Your Employer/Insurer Has an HCO: You may switch to a doctor within the HCO and then to a doctor outside the HCO as described above under You Are Being Treated in an HCO.
What if you want to see you own chiropractor or acupuncturist?
If your employer or insurer does not have an MPN, you may have your treatment transferred to your own chiropractor or acupuncturist if you have pre-designed him or her in writing before you were injured and you have first seen a physician.
There are other situations when you can treat with your own doctor. Your attorney can advise you if that is possible.
Pasadena Workers' Compensation Attorney
At Robert M. Harman & Associates, we care committed to protecting your rights and your future. We have the knowledge and experience to help you obtain the most compensation possible. We will work diligently and will keep you updated throughout the whole process.
Providing Workers' Compensation Services to the Greater Los Angeles Area since 2002
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DISCLAIMER:
The information contained on this web site is of a general nature and is not intended as a substitute for legal advice. No attorney client relationship is created by your viewing of this site or contacting us via e~mail. This web site is intended only to solicit clients within the state of California.
WARNING: Making a false or fraudulent Workers’ Compensation claim is a Felony Subjecto to up to Five Years in Prison or a Fine up to $50,000.00 or Double the Value of the Fraud whichever is Greater, or by both Imprisonment and a Fine.
