Can I See My Own Doctor?
California workers’ compensation law allows you to predesignate and see your personal physician. Otherwise, you might have to choose a doctor within the employer’s network.
Many employers or their workers’ comp insurance carriers establish or contract with a medical provider network (MPN). An MPN is a network of physicians primarily engaged in the treatment of occupational injuries. Once you notify your employer of your injury or file a workers’ compensation claim, the employer will arrange for you to get an initial medical evaluation and begin treatment with a doctor in the employer’s MPN.
You have a right to change doctors within the network after your first visit. If you dispute the doctor’s diagnosis or treatment, you can seek the opinion of another physician in the MPN. If you dispute that doctor’s diagnosis or treatment, then you can seek the opinion of a third physician in the MPN.
Although this system gives you the flexibility to find a doctor you are happy with, you might prefer to be treated by your personal physician if you already have one. This is allowed in certain circumstances, as explained below.
How to choose your own doctor to treat you
If it has been 30 days since your injury and you haven’t received treatment, then you are entitled to see a physician of your choice or go to a facility of your choice and have the treatment paid for by workers’ compensation, so long as the facility is located within a reasonable geographic area.
Also, California workers’ compensation law allows you to predesignate in writing to your employer that you have a personal physician. If this predesignation was done before your injury occurred, then you have the right to be treated by your doctor from the date of injury instead of waiting 30 days. For this provision to apply, you need to have had health care coverage for nonoccupational injuries or illnesses on the date of injury.
Treatment by your chosen physician includes medically appropriate referrals to other doctors or providers as well.
Qualifications for a personal physician
Under California workers’ compensation law, a physician must meet all of the following conditions to be predesignated as the employee’s personal physician:
- Be the employee’s regular physician, duly licensed under California law
- Be the employee’s primary care physician, having previously directed the employee’s medical treatment, and be in possession of the employee’s medical records and health history.
- The physician agrees to be predesignated
The law allows an employee to designate a medical group as a “personal physician” instead of just one doctor alone if the employee so chooses.
A chiropractor can be a treating physician, but only for a limited time
You can initially see a chiropractor as your treating physician. However, chiropractic treatment is limited to 24 appointments paid for by workers’ comp. Therefore, a chiropractor cannot continue as your treating physician beyond the maximum allowable number of visits. The chiropractor would also have to meet the criteria above for predesignation as a treating physician. The same applies to using your personal acupuncturist to treat you.
BEWARE: The insurance company might second-guess your doctor’s choice of treatment
The workers’ comp insurance carrier can require prior authorization of any non-emergency treatment or diagnostic service and may conduct reasonably necessary utilization review in accordance with the law. This means the insurer can require you and your doctor to jump through additional hoops to prove a requested treatment is medically necessary. If you need help navigating this process or if the insurance carrier denies your doctor’s requested medical treatment, a workers’ compensation lawyer might be able to step in and resolve the dispute through informal or formal legal means.
