Workplace injuries are common in California, especially in particular industries. You may fall from a heightened position, slip on the concrete floor, or get affected by dangerous chemicals at the workplace. Also, you may sustain head injuries due to an accident at the construction site.
Besides pain, workplace injuries bring a lot of uncertainty, frustration, and despair. Medical bills, worker compensation claims, and the fear of a permanent disability add to the misery. Not getting the right medical care is the last thing one would want after an injury.
Medical care should be your primary concern when you get injured at the workplace. Choosing the “right doctor” is crucial to your recovery as well as your workers’ compensation claim in California. Making the wrong choice can cost you in many ways. For instance, you may not get proper care, or an inefficient doctor may downplay your injuries, thereby reducing your workers’ comp benefits.
The big question: Do you have the right to choose a doctor once you become injured? Well, the answer is “YES.”
So, what are your options, and how can you choose a doctor after an injury? Let’s find out.
The Initial Treatment
Selecting the right treating doctor for a work injury is the first step for a speedy recovery and successful workers’ compensation claim. The doctor diagnoses your injury and its connection to your work and helps you during your medical and legal battle.
You feel more comfortable talking to your personal primary health care physician rather than visiting a doctor you don’t know. It is important to note that you can go to your personal primary care physician for a work injury only if:
- Your employer provides health care coverage
- Your doctor has your complete medical record
- Your primary physician has agreed to treat your work-related injuries or illnesses (before the injury).
- You have pre-designated your physician and provide your employer in writing:
- Notice that you want to get treated by your personal physician for work-related injuries or illness
- Your personal primary care physician’s name and accurate business address.
Right to Pre-Designate a Doctor for Injury
Injuries can happen anywhere at any time. Not many employees are certain about their treatment options. Some workers think that they can only visit a doctor assigned by their employer or workers’ comp insurance carrier.
However, in California, you can pre-designate a physician to treat you in case of a work injury. Not only you can choose, but also change your doctors if you are not happy with the medical care you receive after an injury. However, for switching a physician, you have to consider several factors (discussed in the next section).
What does Pre-designation Mean?
According to California’s Department of Industrial Relations (DIR), pre-designation is a process of informing your employer that you want to get treatment from your personal physician if you get involved in a work injury. Pre-designating a Doctor of Osteopathy (D. O.) or a Doctor of Medicine (M. D.) is your right. For requirements, see the “Initial Treatment” section.
Pre-designating a Group of Doctors
In California, you also have the right to pre-designate a group of qualified doctors for a work injury or illness. However, the rules are different if your employer has an established Medical Provider Network (MPN) or has a contract with a health care organization (HCO).
In that case, you can pre-designate a group of qualified doctors, including a chiropractor, acupuncturist, or orthopedic. You can download the form California Department of Workers’ Compensation (DWC) website. You may also ask your employer to provide you a pre-designation form once you are hired.
When You Don’t Have a pre-designated Physician
In case you did not designate a doctor for a work injury or illness, you will not get the “choice” of visiting your primary physician for initial treatment. You will have to choose a doctor from the Medical Provider Network (MPN) established by the employer or their insurance carrier.
However, the rule does not apply in certain circumstances. There are two main exceptions
- When you need urgent medical care
- Your employer has not shared any legal requirements and information.
If your employer or insurer has an HCO contract, then you will get the initial treatment in the health care organization for the work injury. However, if you have not pre-designated a doctor, your employer has no MPN or HCO contract, then the right to choose your initial treating doctor goes to the claim administrator. They choose the treating doctor for the first 30 days after the injury.
The Right and Process to Change Your Doctor
Your doctor has a major role in your recovery process. It is important to have a good rapport with the doctor. Your physician should make you feel comfortable and provide you with the best medical care possible. The doctor must make the right decisions about your ability to resume the work.
However, if at any point, you feel that your doctor is not competent or he/she is not providing you proper medical care, you have the right to change your physician. After all, it’s about your wellbeing, and you can’t take any risk.
It is important to note that the process for switching a doctor depends on the timing and health coverage, i.e., an MPN or an HCO, provided by your employer. Also, it depends on whether you have a pre-designated personal primary care physician.
When You Have a pre-designated Personal Physician
You can switch from your pre-designated doctor to one of the network doctors anytime if your company has an MPN or an HCO. However, if they don’t offer these facilities, the rules for switching the doctor depending on the timing of your move.
- If you want to change your doctor within the first 30 days of reporting your injury, you have the right to change the doctor once. But, it is the insurance company which selects the new treating doctor for you.
- You have the right to switch to a doctor of your choice after 30 days when you reported the injury. You have to inform the insurance company about your decision. Also, you have to provide the name and address of your new doctor.
When Your Employer has an MPN
An MPN – Medical Provider Network refers to a network of physicians and health care providers that an employer establishes to treat injured workers. In California, employers have to get approval for an MPN from the state Division of Workers’ Compensation (DWC).
Each MPN comprises a group of doctors who have expertise in on-job injuries and various other medicinal domains. For instance, an MPN includes neurologists, physiatrist, chiropractor, and orthopedics. In California, if your employer has an established MPN, you can change doctors within the network only.
If you are not happy with the “switch,” you may request another change. However, if you feel the third doctor is also not providing proper medical care, you can apply for an “independent medical review” with a neutral medical professional. In case of a successful review, you can choose a physician outside of the MPN.
When Your Employer has an HCO
If your employer has an HCO contract, and you are getting treated at the Health Care Organization (HCO), you may request to switch the doctor once. You can only switch to a medical provider within the HCO. Also, the HCO will choose the new doctor for treating your work injuries or illness.
In case you want to switch to a doctor outside an HCO, you have to wait for a certain period starting from the time you reported the injury.
- If your employer offers health insurance coverage, you have to wait for 180 days, i.e., six months
- If you don’t have the health insurance coverage through work, you have to wait for 90 days.
Make sure that your new treating doctor is located within a reasonable distance from your home. The rules remain the same when you are switching from a pre-designated personal physician to the employers contracted HCO doctor.
When You Don’t Have a pre-designated Physician, MPN, or HOC
In case you did not pre-designate a physician, or your company does not provide an MPN or an HCO, you can still change your doctor. The rules for switching to a new doctor are similar to the rules for changing a doctor when you are receiving medical care from a pre-designated doctor.
- Within the first 30 days after reporting an injury, the insurer chooses the new doctor.
- After 30 days, you have the right to choose any medical care provider for your injury. However, you have to inform the insurer about the new doctor.
If you have any confusion or want to learn about your rights about the workers’ compensation, you can find useful information on the California Division of Workers’ Compensation website. However, the laws can be tricky and difficult to understand. It is better to consult an experienced attorney when you want to choose or change your doctor for a work injury or illness.