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How to Get Medical Treatment in Your Worker's Compensation Case

Actions taken during the first 30 days after filing your worker’s compensation claim are critical. As a rule, your employer is law-bound to provide you with sufficient medical treatment following a workplace injury. But decisions made early on in the process will ultimately determine the level of treatment you receive.

To ensure you get proper medical treatment 3 crucial steps must be taken:

  1. You need to report your injury ASAP

  2. You need to carefully choose your treating doctor

  3. You need to change doctors if you disapprove of or disagree with their treatment

Keep in mind that different states will have different procedures and rules.

Reporting Your Injury

Telling your employer and colleagues of the injury is not sufficient. You will need to formally file a Workers’ Compensation Claim Form, also known as a DWC-1. The form asks you to describe the nature and severity of your injury, and which part of the body was affected. The description you give will be compared to the treating doctor’s diagnosis, so it’s crucial that you are as accurate as possible. If you wait too long to file for workers’ comp, then the symptoms you initially felt may no longer be apparent, affecting the overall amount of treatment you receive.

Your employer should be able to provide you with all the proper forms if requested. But you can always download the appropriate from your local government website. In California, that would be the Department of Industrial Relations’ Division of Workers’ Compensation.

Choosing Your Treating Doctor

Your first treating physician plays a crucial role in diagnosing and treating your condition. They will determine if, when, and how you can return to work based on your level of disability. The nature of your work-place injury or illness is ultimately what decides the exact amount and duration of compensation you may receive.

If possible, always choose a treating doctor you know and trust because the doctors hired by employers and insurance companies are often less than objective. California law has certain rules about how you can select (and change) your treating doctor depending on whether your employer has contracted with a health care organization (HCO) or established its own medical provider network (MPN).

If your employer DOES NOT have a HCO or MPN contract, you may be able to choose your personal primary care physician if certain conditions are met:

  • You have health care that covers treatment outside of work-related injuries or illnesses

  • Your primary care physician agreed to treat you for work-related injuries or illnesses IN ADVANCE

  • You gave your employer notice of predesignation BEFORE being injured. “Predesignation” is simply declaring that your personal doctor will also be your treating doctor in the event of workplace injury or illness. File DWC form 9783 with your employer to make a predesignation.

Note: Even if your employer has contracted with a HCO, you can still predesignate and choose your primary care physician to be your treating doctor. But it will likely be a more complicated process.

If your employer DOES have an HCO or MPN contract and/or If you have not chosen a doctor before the injury occurred, your choices are limited. With an HCO you’ll most likely be treated in the HCO for the first 30 days. With an MPN, you’ll generally have to choose a doctor within that network. If your employer never provided you with the legally required MPN notification, you may be able to choose from your own medical network. And in the event an employee needs immediate emergency care, they will be taken to the nearest hospital even if it’s not part of the employer’s MPN.

Without an HCO, MPN, and predesignation, the claims administrator has the right to choose your treating doctor for the first 30 days following your injury. After that 30-day period, however, you have the right to change to any other doctor who accepts workers’ compensation insurance.

Changing Your Treating Doctor

Many injured workers wrongly assume that they can’t change doctors because their employer chose their initial treating doctor.

If you initially saw a doctor from within your employer’s HCO, you can switch to a new doctor within the HCO during the first 30 days after filing for workers’ comp. You can then switch to a different medical network after a waiting period of 90-days (if you are not covered by employer-provided health insurance) or 180-days (if you are covered by employer-provided health insurance).

If your employer has an MPN, you can change doctors within that MPN. Even if you initially were initially treated by your predesignated primary care physician, if you choose to change doctors, your next choice must now be from within the company’s MPN.

If your employer does not have an HCO or MPN you can change doctors once during the first 30 days of treatment. But even then, you will need to have predesignated your choices before the workplace injury or illness. Otherwise the claims administrator has the right to choose your new physician.

Keep in mind that your treating doctor is not the same as your QME doctor. In the case of a panel QME examination, once you’ve chosen a doctor from the employer’s list, you cannot change.

Know Your Choices

Choosing the right doctor is more than just picking a name from a list. And your choice plays a critical role in determining the quality and quantity of medical treatment you receive. This is a complicated decision made even more complicated given the different state policies.

An experienced workers’ compensation attorney will not only be able to help you choose the right doctor for your case, they will fight to ensure you receive all the medical treatment you are entitled to.

Barsoum Law is here to support you and protect your interests throughout the entire workers’ comp process. We offer a personal focus and individualized care that large corporate firms do not. And our multilingual, multicultural team is dedicated to making sure you obtain the compensation you deserve.

If you have suffered a work-related injury or illness, Barsoum Law can and will help. We have represented thousands of injured workers throughout California the past 25 years. Contact us today at 877-299-1555 or to schedule a consultation with a member of our team.

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