Having the right doctor is important in a worker’s compensation claim. Treating doctors do not only provide medical treatment, they also set work restrictions and refer you to relevant specialists. But sometimes, you might sense that a doctor can be downplaying your injuries for the insurance company to deny your claim or reduce your benefits. If you think that a doctor is not keeping your best interest in mind, remember that you have the right to switch doctors.
The process of switching doctors depends on how your initial treating doctor was selected. In California, if you suffered work-related injuries, you have the right to see a predesignated doctor. A predesignated doctor must be a doctor who you have a history of treatment from. To predesignate a doctor, you must provide a written notice to your employer even before a work-related injury or illness happens. If you don’t have a predesignated doctor, then you’re required to see a doctor chosen by your employer or you can choose from your employer’s medical provider network (MPN).
If you predesignated a doctor, then you have the right to change the doctor anytime. You just need to give a notice to your employer’s insurance company. There will also no limit to the number of times you can switch doctors.
If your employer has an MPN, you can request to change the doctor twice (at least). For the first two times, the replacement doctor will still have to be chosen through the MPN. If you’re still uncomfortable with your third doctor, you can request an independent medical review and explain why you disagree with your third doctor. If your request is approved, you can select a doctor outside the MPN. If denied, you would not be able to switch doctors.
If your employer’s insurance company has a healthcare organization (HCO), you can change doctors once from the HCO. Within 5 days, the HCO must give you a new HCO doctor. If you want to choose a doctor outside the HCO, then you must abide the waiting periods. If your employer doesn’t’ offer health insurance, you have to wait 90 days. If the employer does, you have to wait 180 days.
If your employer doesn’t have an MPN, changing doctors can be a bit more complicated. You may switch doctors within the first 30 days of treatment, but your employer’s insurance company gets to choose the replacement. After 30 days, you may choose your own doctor.
To better guide you about the rules and regulations in switching doctors, consult with an experienced worker’s compensation lawyer.