You got injured on the job, and now you need to see a doctor for treatment. You’re worried about this, because you’re only comfortable with your doctor. Are you going to be able to go to them? Or will you be assigned a doctor through workers’ comp?
By finding out more information, you can figure out a plan of action for your doctors’ visits.
Seeing Your Own Doctor on Workers’ Comp
In California, you can see your own doctor (or qualified medical group) on workers’ comp, but there are some rules surrounding this.
Your employer must provide regular health care coverage, and you need to have given your employer a predesignation, which is a written notice that you’d like your personal physician to provide treatment for your work injuries.
What If You Don’t Have a Predesignation?
If you don’t provide the predesignation, then typically you’ll need to receive your initial treatment from a doctor the insurance company provides or one who is in the insurer’s network of doctors.
However, if you are unsatisfied with the doctor provided, you may be able to switch after the initial treatment period, which is 30 days. Note that the insurance company will typically choose your new doctor. After that 30 day period, you can then switch to your physician by telling the insurance company and giving them your doctor’s name and contact information.
If the insurance company has a Health Care Organization (HCO), you can switch to a doctor outside of it within 180 days if you have health insurance through your employer or 90 days if you have it independently of your employer.
If the insurance company has a Medical Provider Network, or an MPN, then you can switch doctors after you have your first exam. You’ll likely need to use a network provider, though.
Maybe you’re in this scenario: you don’t have a predesignation, and there is no HCO or MPN. In the initial 30 days, you’ll have to work with the insurance company’s provider. After that, you can switch if you tell the insurance company about it.
Keep in mind that changing doctors will require agreement by the doctor. The doctor’s office often requires a review of your medical records before deciding whether to accept you as a workers’ compensation patient.
What to Do If You Get Injured at Work
If you get injured at work, you’ll need to tell your employer right away and file a workers’ comp report. Make sure you get a copy of the report. If you fail to report the injury or illness within 30 days, then you may not be able to receive your workers’ comp benefits. It is important to discuss this issue with an attorney as you will likely be entitled to benefits.
You should also seek immediate treatment if there is an emergency. If the illness or injury happened over time, make sure you go to the doctor for treatment as well.
If you are an employee in California, your employer is obligated to provide workers’ comp. If you are an independent contractor, you are not entitled to workers’ comp. Whether you are an employee or an independent contractor depends on the factual circumstances of your job. A workers’ compensation attorney will be able to advise you on your employment status.
While you are out of work due to a workers’ comp claim, you’ll receive temporary or permanent disability benefits depending on the nature of your illness or injury. Workers’ comp should cover your medical expenses including appointments, surgeries, prescription, and medical equipment you may need to heal. Medical treatment must be authorized by the workers’ compensation insurance company or self-insured employer. If treatment is not authorized there are strict timelines to appeal the denial of treatment.
Contacting Tichy Law
If you’ve been injured at work and you’re trying to navigate the rules of workers’ comp in California, then contact a workers’ compensation attorney at Tichy Law Inc. (916) 444-0321 for a free consultation. We look forward to assisting you at this time.
