Ask the Lawyer:
Can I Choose or Switch My Workman’s Comp* Doctor?
If you have been injured at work, your treating doctor is extremely important in your California workers’ compensation claim. Your treating physician directs the course your medical treatment, issues your work restrictions, and refers you to specialists.
But, unfortunately, in some cases having the wrong treating doctor can sometimes result in inadequate medical treatment – or even a failure to properly assess your injuries, resulting in a denial of your workers comp claim and even a reduction of your benefits.
In this article our experienced Long Beach workman’s comp lawyers explain how California workers can switch doctors if they are dissatisfied with their treatment. However, because an injured worker must follow specific rules and steps when switching treating doctors, it is always wise to consult with an experienced workman’s comp attorney first.
Choosing a Treating Doctor in a Workman’s* Comp Case
In California, workers may “predesignated” a personal physician by designating them in advance – under certain circumstances. However, if you have a workman’s comp claim and you did not predesignate a doctor before your injury, your initial treatment typically must be by a physician chosen by the insurance company and/or within the insurance company’s network of doctors.
California’s rules regarding pre-designated physicians vary depending on whether the insurance company has a managed provider network (MPN) or a health care organization (HCO). So it is always wise to consult with an experienced workman’s comp attorney.
When Can I Switch Doctors in a Workman’s* Comp Case?
In California, you may change doctors if you are dissatisfied with your medical treatment. However, these rules also vary depending upon: whether you have predesignated a personal physician; and whether the insurance company has a managed provider network (MPN) or a health care organization (HCO).
If you do not follow the correct procedures for switching doctors, the insurance company may refuse to pay for your related medical bills.
Switching Workers Comp Doctors from a Predesignated Personal Physician
If you are receiving treatment from your personal pre-designated doctor, California workers’ compensation law allows you to switch to another physician.
- If the insurance company has an MPN or HCO, you can switch from your predesignated doctor to a network physician at any time.
- If the insurance company has an MPN, you may change doctors any time after your first examination. However, you typically must treat with a network physician or provider for the duration of your workers’ compensation claim.
- If the insurance company has an HCO, you may request a doctor change at least once and, the HCO must give you a new HCO provider within 5 days.
- If the insurance company does not have an MPN or HCO, during the first 30 days of treatment, you may change doctors once – BUT the insurance company will select your new doctor.
- If the insurance company does not have an MPN or HCO, after 30 days of treatment, you can transfer to a doctor of your own choosing – provided you must notify the insurance company of the change and the new doctor’s name and address (which should be done in writing).
When You Do Not Have a Predesignated Doctor, MPN, or HCO
If you did not predesignate a doctor – AND the insurance company does not have either an HCO or MPN – you can change doctors once during the first 30 days of treatment. However, the insurance company will typically be allowed to choose your new doctor for you.
After 30 days of treatment, you can choose your own doctor or medical provider. But before you treat with a new physician, you must notify the insurance company. While not required, it is recommended to send written notice, which include your new doctor’s name and address.
Which Rules Apply to ME for Switching Workers* Comp Doctors?
These rules are very complex – and the information in this article is intended only as general or typical information. But this information should not be taken as specific advice that applies in your situation.
Before you switch doctors in a workman’s comp case, you should always consult with your own lawyer. If you do not yet have a lawyer for your workmans comp case – and you live or worked in Long Beach, Orange County, Los Angeles or Southern California – our lawyers will give you a free consultation.
Call Our Long Beach Workmans Compensation Lawyers: 562-622-4800
* Note: The correct terminology for an injured worker case is “workers’ compensation.” However, many people still use the term “workmans comp”. For this reason our article uses all of these terms interchangeably, from time to time, in order to help injured employees find our articles on the Internet.