TL;DR: If you don’t agree with the doctor’s findings during your California workers’ compensation claim, you can request a second opinion, switch doctors (based on your MPN or HCO status), or seek an independent medical review. A workers’ comp attorney can guide you on your next steps.
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Physicians are fallible, and it is always possible for them to make mistakes. For example, 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 treat the injuries you suffered at your workplace. An incomplete medical report might weaken a worker’s compensation case.
If you believe your medical evaluation is incorrect or incomplete, workers’ compensation lawyers can review your case, explain your options for requesting a second opinion, and help you navigate disputes with your employer’s insurance provider. For guidance about your situation, call (888) 488-1391 to speak with a workplace injury lawyer familiar with California’s workers’ compensation system.
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 might misjudge a patient’s symptoms; other doctors may 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 could affect your workers’ compensation case. You may also suffer from additional injuries due to the potentially faulty advice you received from a doctor. These issues may lead to disputes as you pursue compensation for your workplace injuries.
You may believe that the doctor has not provided you with an appropriate course of treatment. A California workers’ compensation lawyer can discuss whether you may be able to counter the physician’s medical report and seek a second medical opinion from a different doctor. Your ability to do so will likely depend 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 Workers’ Compensation Case
The medical opinion of a treating physician is important to any workers’ 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 workers’ compensation case.
The following are some of the activities performed by a treating physician that may affect your workers’ compensation case.
Offering Evidence For Your Workers’ 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 workers’ compensation case. Also, treating physicians often testify either during depositions or hearings.
Assessing Your Status Regarding Permanent Disability
After you 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 may influence whether you qualify for permanent disability benefits.
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 may sustain additional injuries that will prevent you from fully recovering in a timely manner.
Specialist Referrals
Under many circumstances, a treating physician will approve referrals you receive to visit a medical expert, such as a cardiologist or an orthopedic surgeon. A treating physician will assess your reported symptoms and direct you to more relevant healthcare professionals who can help treat your injuries.
Assessment And Diagnosis
If you want to pursue workers’ compensation benefits, you need an official medical diagnosis from a treating physician. Also, a treating physician will make an assessment to 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. Some may dictate that you can only choose a treating physician from an employer’s healthcare network or from a select group of doctors. Other states allow the employer to assign a treating physician in workers’ compensation cases. California, specifically, 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.
Designating A Treating Physician For A Workers’ Compensation Case
In states where injured workers are permitted to choose their own treating physician, this option can be advantageous. As you evaluate your options, consider factors such as:
- 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 workers’ compensation medical fee schedule.
- The physician’s knowledge of workers’ 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 was trained to practice a particular field of medicine.
- The physician’s skill level and amount of experience.
It is also important that you feel comfortable sharing your experiences and impressions with your treating physician. Trust and clear communication can help support accurate treatment and documentation of your condition.
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, complete the form provided by the California Department of Workers’ Compensation (DWC Form 9783). This and other 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
It can help to have a healthy relationship with your treating physician. Such a relationship could help you feel confident in the care you’re receiving and in your physician’s judgment about your recovery and ability to return to work. It may be that you do not agree with the recommendations made by your treating physician, and under these circumstances, you may be able 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 others who could help with physical recovery, such as an 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. As per Cal. Labor Code §§ 4616.3, 4616.4, you may also change treating physicians again under reasonable circumstances.
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 within 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 among your available options 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, here are some steps to consider:
- One option is to submit a written notice to your workers’ compensation claims administrator stating that you disagree with the treating physician’s assessment. 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.
- You could also have the claims administrator help you find another treating physician who will give you a second medical opinion.
Contact Arash Law’s Workers’ Compensation Lawyers In California
Arash Law helps injured victims seek financial compensation for injuries caused by another’s negligence. We have years of combined experience representing clients in workers’ compensation cases. We also assist with various personal injury claims throughout California. If you decide to work with us on a valid claim, we’ll work to focus on your case and advocate for your rights throughout the process.
Contact our workplace accident attorneys at (888) 488-1391 to schedule a free initial consultation. Our work injury lawyers serve employees who need assistance with their workers’ compensation claims.
