Can I Choose My Own Doctor for Workers’ Compensation in California?

If you’re injured at work in California, one of the first questions that might come to mind is, “Can I choose my own doctor for workers’ compensation?” While the simple answer is sometimes, the full answer depends on several factors, including the type of injury, your employer’s policies, and California’s workers’ compensation laws.

Navigating the workers’ comp system can be complicated, and understanding your rights when it comes to medical treatment is essential for getting the care you need and ensuring your workers’ compensation claim proceeds smoothly.

In this blog post, we’ll walk you through the rules regarding choosing your own doctor for workers’ compensation claims in California and help clarify what options are available to you.

California Workers’ Compensation: The Basics

Before diving into whether you can choose your own doctor, let’s review the basics of California’s workers’ compensation system. Workers’ comp provides benefits for employees who are injured or become ill due to their job. These benefits can include:

Medical treatment for your injuries or illness
Temporary disability benefits if you need to miss work while recovering
Permanent disability benefits if the injury causes long-term impairment
Rehabilitation services if you need retraining for a new job
Death benefits for the family of a deceased worker

The medical treatment aspect of your workers’ compensation claim is crucial, so knowing whether you can choose your own doctor is a key part of your recovery.

Can You Choose Your Own Doctor in California?

The short answer is yes, but with some important rules and limitations. In California, whether you can choose your own doctor depends on the timing of your injury and the policies your employer has in place.

Let’s break this down further.

1. Initial Medical Treatment and Employer’s Right to Choose a Doctor

After a work-related injury, your employer generally has the right to direct your medical treatment at the outset of the claim, but only under certain conditions. Here’s how it works:

Employer’s Medical Provider Network (MPN): Many California employers have a Medical Provider Network (MPN), which is a list of doctors and healthcare providers approved to treat workers injured on the job. If your employer has an MPN, they will likely send you to a doctor within the network for initial treatment.In this case, you must receive care from an MPN doctor for the first 30 days after your injury. During this time, you typically cannot choose your own doctor unless you meet certain requirements.

2. Can You Change Doctors Within the MPN?

Yes, in California, even if you start treatment with a doctor from your employer’s MPN, you can change doctors—but there are some rules:

First 30 Days: If you are within the first 30 days after your injury, you can change doctors within the MPNwithout needing special approval.
After 30 Days: Once the first 30 days have passed, you will need to formally request to change your doctor if you want to switch from one provider within the MPN to another. This typically requires notifying your claims administrator.

3. What If Your Employer Doesn’t Have an MPN?

If your employer does not have an MPN or a network of doctors, you are allowed to choose your own doctor from the beginning of your claim. In this situation, the California Division of Workers’ Compensation (DWC) has a set of rules to guide your choice:

Access to care: You are entitled to choose any physician who is licensed to practice in California, as long as that doctor agrees to treat workers’ compensation patients.
Notice of Rights: If your employer does not have an MPN, they are required to give you a Notice of Personal Physician form, which allows you to designate your own personal physician or healthcare provider to treat you in the event of a work injury.

4. Personal Physician: Can You Use Your Regular Doctor?

In some cases, if you have a pre-existing relationship with a doctor, you may be able to see them for your work injury, provided the doctor is willing to treat workers’ compensation patients. This is especially true if:

Your doctor is your primary care physician: If you’ve been seeing the same doctor for other health conditions before your injury, and the doctor is willing to treat you for your work injury, you may be able to continue seeing them.
Your doctor is qualified: The doctor must be licensed and willing to treat you under the workers’ compensation system.

However, this option requires that you have notified your employer in advance, using the Pre-Designation of Personal Physician form. If you’ve filled out and submitted this form before your injury (or before you file your workers’ compensation claim), you can choose your own physician.

Important: If you haven’t pre-designated your personal physician, you may be limited in your ability to choose your own doctor initially and will likely be required to go through the MPN or another employer-approved provider for the first 30 days.

5. When Can You Choose a Doctor Outside of the MPN?

After 30 days of treatment, if you’re still dissatisfied with the care you’re receiving or you feel your recovery isn’t progressing as expected, you may have the option to seek a doctor outside of the MPN, with some important caveats:

Approval Required: You will need approval from your claims administrator (the workers’ comp insurance company or the employer’s insurer). The request is often made in writing.
Emergency Care: If you require emergency care, you can see any doctor immediately, even if they are not within the MPN.

6. What About Specialists or Second Opinions?

If you need to see a specialist or get a second opinion, your workers’ compensation insurer may approve treatment with a different doctor, especially if it’s necessary for your recovery. Here are some key points:

Specialty care: If your injury requires specialized treatment (e.g., orthopedic surgery, physical therapy, or pain management), you may be able to request a referral from your treating doctor to see a specialist.
Second opinions: If you disagree with your doctor’s diagnosis or treatment plan, you can request a second opinion. In some cases, you may have to ask for approval from your insurer, but the second opinion may be essential in ensuring you get the right care.

7. How to Ensure You Get the Right Doctor and Care

If you’re navigating the California workers’ compensation system and want to make sure you get the medical care you need, here are a few tips:

Know Your Rights: Familiarize yourself with the workers’ compensation rules in California, especially regarding the MPN and the right to choose your doctor.
Pre-designate your doctor: If you have a personal physician who is willing to treat you for workers’ comp injuries, make sure to submit the Pre-Designation of Personal Physician form to your employer before an injury occurs.
Ask for help: If you feel your treatment is not progressing or if you want to change doctors, it’s important to notify your workers’ comp claims administrator and follow the proper procedure.
Consult with an attorney: If you encounter challenges in choosing your doctor or getting the medical care you need, consider consulting with an experienced workers’ compensation attorney. An attorney can help ensure that you receive the best possible care and guide you through the process of changing doctors, requesting second opinions, or dealing with denied medical treatment.

Conclusion: Yes, You Can Choose Your Own Doctor in California—But There Are Rules

While you do have the right to choose your own doctor for workers’ compensation in California, it depends on your employer’s policies and your actions. If your employer has an MPN, you will generally need to receive treatment from a doctor within that network for the first 30 days. However, after that period, or if your employer doesn’t have an MPN, you can seek care from any doctor that is approved by the workers’ compensation system.

If you want to make sure you have the flexibility to choose your doctor, it’s a good idea to fill out the Pre-Designation of Personal Physician form before you get injured.

If you’re facing challenges with your workers’ comp claim or have questions about choosing a doctor, don’t hesitate to reach out to an attorney who can help protect your rights and guide you through the system.

Need legal help? In California, navigating legal challenges, whether they involve personal injury, workers’ compensation, criminal defense or civil litigation, can be overwhelming. Khoury Law Group is here to provide the critical legal support you need. As a leading advocate for individuals facing legal battles, our experienced attorneys understand the complexities of the legal system and are committed to fighting for your best interests. With personalized legal strategies and compassionate support, we are dedicated to achieving the justice and compensation you deserve.

CONTACT US FOR HELP. Call us at (888) 354-6879 or fill out the form on our Contact page.