Can I Choose My Own Doctor to Treat My Work Injury?

When you’re hurt on the job in California, the doctor who treats your injuries will play an important role in your recovery, as well as the workers’ compensation benefits you receive. Many injured workers are surprised to learn that there are limitations to who can treat your work-related injuries.

Choosing an Initial Treating Healthcare Provider

In many cases, the doctor that treats your work injuries must be chosen from a pre-approved list provided by your employer’s workers’ compensation insurance company. Selecting your treating doctor can be one of the most important decisions you make in your workers’ comp. Case.

Your employer will provide you with a list of approved medical providers whose services will be covered by their workers’ compensation insurance policy. You may switch doctors if you do not like your first choice, as long as your second choice is chosen from the same approved list.

Your chosen medical provider will diagnose your medical condition, recommend treatment, refer you to specialists, take you off work or restrict your job duties if necessary, and decide whether you have a permanent disability due to your work injury.

Since this doctor will be so critical to your treatment and eligibility for benefits, it is important to choose carefully.

Pre-Designating a Healthcare Provider

Many people have a family doctor they have developed a relationship with over many years. Through a process known as “pre-designation,” you can select a doctor of your choosing to be your care provider in the event that you are injured at work. This must be done before an injury occurs, and is often completed upon hiring.

Generally, you will provide your employer with information about the doctor along with a written agreement from your physician stating that they will treat you for any occupational injuries. The doctor you choose must be approved by your employer’s workers’ compensation insurance company.

Changing Your Treating Healthcare Provider

If you are not happy with the medical care provided by your treating doctor, or you disagree with their opinions and recommendations, you may switch to another physician according to the procedures that match your situation.

Managed Provider Network (MPN)

If your employer’s insurance company has an MPN, you may change doctors any time after your first examination. However, you are limited to the providers on the list they provide.

Health Care Organization (HCO)

You may request to change doctors, but the HCO will assign you the new provider. You may switch to a doctor outside the HCO after a waiting period that starts when you reported your injury: 

• 90 days if you don’t have regular health insurance through work.

• 180 days if you do have employer-provided coverage.

Predesignated Personal Physician

If you are unhappy with your pre designated physician, you may switch to a network physician at any time. If there’s no MPN or HCO, you may change your doctor as follows:

• During the first 30 days after your injury, you may change doctors once, but the insurance company will likely select your new doctor.

• After 30 days, you may transfer to a doctor of your choosing. You must notify the insurance company of the change and provide it with your new doctor’s name and address.

No Predesignated Doctor, MPN, or HCO

If you did not predesignate and the insurance company doesn’t have an MPN or HCO, you may change your doctor based on timing: 

• During the first 30 days after your injury report, the insurance company typically chooses the new physician. 

• After 30 days, you can switch to a medical provider of your choosing, as long as you notify the insurer about your new doctor.

If you’ve been injured on the job and are having trouble getting the medical care you require, an experienced workers’ compensation attorney can guide you through the process of choosing or changing doctors.

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Cole, Fisher, Cole, O’Keefe + Mahoney is Central California’s leading workers’ compensation and social security disability law firm. With over 30 years of successful experience, we are committed to securing maximum benefits for our clients in the Fresno, California area. Schedule a free consultation today.