Physicians are fallible, and it is always possible for them to make mistakes. In fact, a doctor’s medical report may not contain sufficient information regarding your bodily injuries. Also, a doctor may not include details regarding the medical treatment you need to receive to treat the injuries you suffered at your workplace. An incomplete medical report can weaken a worker’s compensation case.
It Is Possible for Physicians to Be Wrong
You may have seen more than one medical doctor at some point in your life. It is obvious to many patients that physicians have different medical opinions. Some doctors can misjudge a patient’s symptoms; other doctors can prescribe unnecessary medical procedures. Also, a physician may recommend that a patient perform a specific kind of work during their recovery when this type of work can exacerbate the patient’s injuries.
Receiving incorrect medical information from a physician regarding your injuries can weaken your worker’s compensation case. You may also suffer from additional injuries due to the faulty advice you received from a doctor. These issues can potentially decrease the financial compensation you will receive due to your workplace injuries.
You may believe that the doctor has not provided you with an appropriate course of treatment. A California worker’s compensation lawyer can help you object to the physician’s medical report and seek a second medical opinion from a different doctor. Achieving this goal depends on whether you receive medical treatment within a healthcare organization (HCO), a medical provider network (MPN), or neither.
How a Treating Physician Can Influence a Worker’s Compensation Case
The medical opinion of a treating physician is important to any worker’s compensation case. A treating physician spends a significant amount of time treating a patient. An individual’s medical condition is assessed over a long period of time by a treating physician. A treating physician possesses knowledge regarding whether or not a patient will make a full recovery. Also, a treating physician knows a patient’s physical condition and whether the patient requires medical treatment. Therefore, a treating physician will have in-depth knowledge of a patient’s injuries. These factors are all relevant to any worker’s compensation case.
The following are some of the activities performed by a treating physician that will affect your worker’s compensation case.
Offering Evidence for Your Worker’s Compensation Case
It is necessary to review all the medical records associated with the treatment you received from your treating physician. A treating physician will create a comprehensive set of medical records and reports regarding your treatment. These records can help you substantiate your claims in your worker’s compensation case. Also, treating physicians often testify either during depositions or hearings.
Assessing Your Status Regarding Permanent Disability
After you stabilize and begin to reach a stable medical condition, a treating physician will assess whether or not you suffer from a temporary or permanent disability. Your treating physician will make a medical determination regarding any disability you suffer from, which will influence the amount of permanent disability benefits you will receive.
Specifying the Nature and Extent of Any Work Limitations
A treating physician will determine if you should return to work or if you should take time off to recover from your injuries. You may qualify for temporary disability benefits. If you are ordered to take time off from work, a treating physician will determine when you will be permitted to go back to work. It can be risky to return to work prematurely because you can cause additional injuries that will prevent you from fully recovering in a timely manner.
Specialist Referrals
Under most circumstances, a treating physician will approve referrals you receive to visit a medical specialist such as a cardiologist or an orthopedic surgeon. A treating physician will assess your reported symptoms and direct your medical specialists who can help treat your injuries.
Assessment and Diagnosis
If you want to receive workers’ compensation benefits, you need an official medical diagnosis from a treating physician. Also, a treating physician will make an assessment and determine if you need specific medications or physical rehabilitation.
How Am I Assigned a Treating Physician?
Every state enforces unique policies and procedures for selecting and assigning treating physicians. One particular state may allow you to assign your own treating physician at the outset of your case. California, for example, permits patients to designate their primary care physician as their treating physician, but this designation must have been made before the date of the injury.
Another state may dictate that you can only choose a treating physician from an employer’s healthcare network or from a select group of doctors. Also, other states allow the employer to assign the treating physician in workers’ compensation cases.
Designating a Treating Physician for a Workers’ Compensation Case
If you reside in a state that allows you to designate your own treating physician, take advantage of this privilege. As you analyze the physicians available in your geographic area, you should consider the following characteristics:
- The physician’s distance from your home
- Whether or not the physician has open availability for appointments
- Whether or not the physician will accept the required worker’s compensation medical fee schedule
- The physician’s knowledge of worker’s compensation claims
- The physician’s experience advocates for injured workers
- The physician’s understanding of the specific types of injuries you suffered
- Whether or not the physician specializes in a particular field of medicine
- The physician’s skill level and amount of experience
You should also be comfortable sharing your experiences and impressions with your treating physician. It will benefit you if you trust your treating physician and enjoy speaking with them.
Deciding on Who to Designate as Your Treating Physician
In California, it is possible for you to see a primary care physician immediately after your injuries, provided the following is true:
- The primary care physician has confirmed that they consent to provide medical treatment for any workplace injuries you suffer.
- You have provided your employer with a written document designating the primary care physician as your treating physician before the date of injury.
- You are covered for medical treatment that is not associated with your workplace injuries.
It is also permissible for you to choose a qualified medical group as part of your predesignation. To verify your predesignation, you should complete the form provided by the California Department of Workers’ Compensation (DWC Form 9783). These requirements may vary depending on whether the employer or their insurance company entered into a contract with a healthcare organization to offer medical care for workplace injuries.
If the employer has entered into a contract with their insurance company, then it is possible for an employer to permit you to predesignate your treating physician. Under Cal. Labor Code §§ 4600, 4600.3, the employer has to provide you with a predesignation form upon your date of hire and every following year.
It may be that you did not predesignate your treating physician. If so, then you will not be permitted to pick the first doctor you visit for your medical treatment. If your employer or their insurance provider has selected a medical provider network, then you will pick a treating physician from the in-network physicians.
The following exceptions may apply:
- Your employer may not have provided you with specific notices and information required by law.
- You are in need of immediate emergency medical treatment.
If the insurance company has entered into a contract with a healthcare organization, then you will need to seek medical treatment from within the healthcare organization after you have suffered an injury. Under Cal. Labor Code §§ 4600, 4600.3, and 4613.3, the claims administrator typically has the authority to choose your treating physician during the 30-day period after the date of the injury. However, these provisions apply only if no MPN or HCO contract exists.
Choosing a Different Treating Physician
You need to have a healthy relationship with your treating physician. Not only should you trust that you are receiving the best medical care possible, but you also need to believe that your treating physician knows the best time for you to return to work. It may be that you do not agree with the recommendations made by your treating physician, and under these circumstances, it may be best for you to choose a different treating physician. Whether your employer has an HCO or an MPN will determine the procedures you need to follow to change treating physicians.
Your Employer Uses an HCO
If your employer uses an HCO, you are allowed to change treating physicians once. However, you must choose a treating physician within the HCO. A 180-day waiting period applies if you have health insurance through your employer. Also, a 90–day waiting period applies if you do not have health insurance through your employer. If you change treating physicians, the new treating physician must be relatively close to your place of residence. These same rules are operative under Cal. Labor Code § 4600.3 if you have a predesignated treating physician but your employer or their insurance company has not contracted with an HCO.
Your Employer Uses an MPN
If your employer uses an MPN, you are permitted to change treating physicians twice. However, the second and third physicians need to be from the MPN. This rule still applies if you have been visiting a predesignated treating physician. You may disagree with the medical opinion delivered by the third physician. If so, you can apply for an “independent medical review” from a neutral physician. Under Cal. Labor Code § 4616.3, 4616.5, after your application is reviewed, you may be permitted to choose a treating physician from outside the MPN.
Your Employer Does Not Use an HCO or an MPN
Your employer may not have an MPN. Also, your employer may not have entered into a contract with an HCO. If these circumstances exist, you are permitted to change treating physicians once during the 30-day period after you report your injuries. You may not have provided your employer with the contact details of your acupuncturist or personal chiropractor before you suffered injuries. If so, the claims administrator may assign a new treating physician if done within five days of the request. Once 30 days pass, you can select a new treating physician located within a reasonable geographic distance from your place of residence. You may also change treating physicians again under reasonable circumstances. Cal. Labor Code §§ 4616.3, 4616.4.
What Can I Do If I Still Notice Problems with the Medical Report?
What Can I Do If I Still Notice Problems with the Medical Report?If you receive medical care through an MPN, you are permitted to seek additional medical opinions from a maximum of two additional physicians inside the MPN. You can visit the physicians up to 60 days after you are given the new roster of doctors. If you do not see the physicians within the 60-day period, you may forfeit the ability to visit these other physicians.
You can seek an independent medical review from the Division of Workers’ Compensation. Doing so may be the best option if you are unsatisfied with the medical opinions of the three doctors in the MPN. A California workers’ compensation attorney can help you understand your options.
If you are receiving medical treatment through an HCO and you want to change treating physicians, you can seek another medical opinion from a doctor inside the HCO. If you are still dissatisfied with the medical opinions you receive, you can request that the HCO perform an “expedited grievance procedure.” The HCO will oversee a complete analysis of your workers’ compensation case in 30 days.
What If I Need Additional Medical Treatment and I Do Not Receive Treatment in an HCO or MPN?
You may be seeing a treating physician outside of an HCO or MPN. You can attempt to change treating physicians. If you are unable to do so, then take the steps listed below.
- Provide written notice to your workers’ compensation claims administrator that you disagree with the treating physician’s opinion. Send the letter within 30 days if you do not have legal representation. If you do have a workers’ comp injury attorney, then send the letter in 20 days.
- The claims administrator should help you find another treating physician who will give you a second medical opinion.
Contact Arash Law’s Worker’s Compensation Lawyers California Trusts by Arash Khorsandi, Esq.
Arash Law, founded by famous attorney Arash Khorsandi, Esq., helps injured victims seek financial compensation for their injuries. We have decades of experience representing clients in workers’ compensation cases. We have recovered over $750 million for clients throughout California. We focus on your case, and we are not afraid to stand up to employers and assert the rights of our clients.
Contact Arash Law, led by Arash Khorsandi, Esq., at (888) 488-1391 to schedule a free consultation. Our workers’ compensation attorneys serve employees who need assistance with their workers’ compensation cases.
