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Who chooses treating doctors in a workers’ compensation case?

On Behalf of | Sep 8, 2023 | Workers' Compensation |

When a San Diego worker is injured on the job, they will need to seek treatment. This is essential not just for their physical recovery, but for a workers’ compensation claim. Of course, when the injury is serious and warrants emergency care, they will be taken to the hospital where the available physicians will provide treatment.

If it is less severe and the worker has time to decide which doctor to go to, there might be confusion as to the selection process. People should know what doctors they can and cannot see because this could impact their treatment and their workers’ compensation case. Knowing about this process can avoid missteps that might hinder the chance of getting approved for benefits.

Know the facts about medical care with workers’ compensation

If it is a non-emergency, there are rules under California workers’ compensation for which physicians the injured worker can see. The treating doctor hinges on whether the employer or the workers’ compensation insurance provider has a medical provider network, a health care organization or the worker had selected their own physician or medical group prior to the injury.

Workers who already selected a physician or a medical group can see that physician to treat the injury. The MPN is in place to treat injured workers. The Division of Workers’ Compensation must approve the MPNs before they can be used. Those who have not predesignated a physician will use a doctor from the MPN.

The HCO is essentially a contractor that has an agreement with the employer or insurer. This is not considered common, but it does happen. If this is the case, the employee will have the right to join the HCO after they have been hired. If they do, the first treating physician will come from that group.

When there is neither an MPN or an HCO, the claims administrator will select the physician. The worker will later have the choice of switching to another doctor. This depends on which entity is treating them.

It is wise to have guidance when seeking workers’ compensation

Workers who have been injured and need medical treatment need to be aware of the rules for who can provide that care. A work accident can happen to anyone whether it is a physically taxing job or one that is less stressful. Those who work in physical-type jobs are at greater risk. Blue collar workers who are involved in construction, warehouse work, iron work and machinists are prone to work injuries. It might be impact-related, cumulative, a muscle tear or due to an accident.

The fundamental part of a successful workers’ compensation case is gathering evidence, filing the claim in a timely manner and making sure to follow the medical guidance. Still, that does not mean the case will be simple.

There could be a disagreement between medical professionals as to the injury severity. People might want to see a specific physician and encounter resistance from the employer and the workers’ compensation insurer. Given the lost income, medical costs, long-term challenges and other issues that accompany a work accident, it is vital to know the requirements and treatment options.