Choosing the doctor who treats a work injury can be especially important for first responders whose recovery may determine when they can return to physically demanding duties. But California workers’ compensation rules do not always allow an injured employee to immediately select any physician they want.
The options available to Oakland police officers, firefighters, paramedics, and other public-safety employees depend largely on whether their employer uses a Medical Provider Network (MPN), whether they predesignated a personal physician before the injury, and how long they have been receiving treatment.
We help first responders understand their medical-care options when questions about treatment arise. Work comp lawyers in Oakland can also review whether the proper doctor-selection rules are being followed in a particular claim.
Can I choose my own doctor?
Sometimes. California workers’ compensation allows injured workers to choose or change doctors in several circumstances, but the rules depend on how medical care is arranged through the employer.
You may have greater control over your treating physician if:
- You properly predesignated your personal physician before the injury
- Your employer uses an MPN, and you want to select another doctor within that network
- Your employer does not use an MPN or Health Care Organization (HCO) and the initial 30-day period has passed
Before scheduling treatment with a different physician on your own, it is important to determine which rules apply to your claim. Treatment outside the applicable system may create disputes over authorization or payment.
What if my department uses a Medical Provider Network?
A Medical Provider Network is a group of physicians approved to provide workers’ compensation treatment. If your employer or claims administrator uses an MPN and you did not properly predesignate a personal physician, your initial treatment will generally take place within that network.
That does not necessarily mean you must remain with the first doctor you see. After your initial examination, you can generally select another physician within the MPN. You may also make additional reasonable changes to another MPN physician if needed.
For a first responder, that can matter when an injury requires treatment from a physician experienced with orthopedic injuries, repetitive trauma, occupational illness, or another condition connected to public-safety work.
Can I see a doctor outside the MPN?
Generally, workers covered by an MPN must receive treatment within the network unless an exception applies. Simply preferring a doctor who is outside the MPN does not automatically allow you to transfer your workers’ comp treatment to that physician. If you want to change doctors, first determine whether the physician is part of the applicable network and whether another rule permits treatment outside it.
What if I predesignated my personal physician?
Predesignation can allow an injured worker to receive workers’ compensation treatment from a personal physician immediately after an injury rather than beginning with a doctor selected through the employer’s workers’ comp system.
However, predesignation generally must occur before the work injury and must satisfy California’s requirements. Among other things, the worker generally must have qualifying health coverage, provide the employer with written notice identifying the physician or medical group before the injury, and have the physician or medical group agree to the predesignation.
What if my employer does not use an MPN or HCO?
If there is no MPN or HCO and you did not predesignate a physician, the claims administrator generally has the right to select your treating doctor during the first 30 days after the employer learns of the injury.
After that initial 30-day period, you may generally choose a physician or medical facility within a reasonable geographic area. This can give an injured first responder more flexibility, but it is still worth confirming that the change complies with workers’ compensation requirements before transferring care.
How can our work comp lawyers in Oakland help you if you want to change doctors?
Questions about doctor choice can affect both your treatment and the direction of your workers’ comp claim. From the Lakeside Apartments District to neighborhoods across Oakland, our attorneys can review how your medical care has been arranged, whether a different physician may be available, and what steps you can take if a requested change is denied.
We can also look into protections that apply if you’re fired after filing a claim and explore your options if your employer doesn’t carry workers’ comp insurance. Contact our team to arrange a free consultation and discuss the details of your claim. Call us without delay!
