Injured workers are sometimes not satisfied with the medical treatment they are receiving for their work injury. For a number of reasons, choosing the best treating doctor in your workers’ compensation case is a very important decision. Your treating doctor, known in California workers’ compensation as the Primary Treating Physician (PTP) plays a critical role in your case.
The PTP is responsible for prescribing all medical treatment, establishing work limitations & restrictions, and providing referrals to other health care providers including surgeons and diagnostic testing facilities who provide medical treatments, opinions, and information related to your workers’ compensation case. The PTP, and other doctors you may be referred to, therefore do not only make important decisions about your medical care, their opinions can affect your entitlement to further medical treatment and disability benefits. The rules and regulations that apply to changing your PTP are complicated. So, you should consult with the Law Offices of Marc Francis, workers compensation attorneys in Sonoma County, for a free consultation before making these important decisions.
Under state law, employees may sometimes predesignate a personal doctor in advance of a work injury. There are important rules and regulations that apply to your predesignation of a personal doctor.
As examples, the designation must be made before the work injury; the workers’ compensation insurance carrier will pay for services only under the workers’ compensation fee schedule; and the doctor must comply with applicable reporting requirements so that the insurance carrier can be required to pay disability benefits in line with the doctor’s opinions.
If you did not predesignate a personal doctor as your PTP in your workers’ compensation case you may be required to receive work injury treatment from doctors listed on your employer’s insurance carrier’s Medical Provider Network (MPN) or Health Care Organization (HCO).
If you have an existing predesignated doctor treating you for your work injury you may change doctors at any time to another doctor within the MPN or HCO by providing proper notice to the workers’ compensation insurance carrier. In most cases switching from a predesignated doctor to a network doctor means you must stay in the network for the remainder of your work injury case.
There are limitations on changing PTP doctors under certain circumstances so it is best to consult with an experienced workers compensation attorney in Sonoma County for more information.
If the workers’ compensation insurance carrier does not have an MPN or HCO and you did not predesignate a personal doctor you may select the doctor of your choice, but special rules apply.
If you don’t follow the applicable rules and regulations in selecting your PTP there may be complications that could negatively affect your entitlement to treatment and disability payments. For example, the workers’ compensation insurance carrier may refuse to pay the doctor for services, or the doctor’s reports may not be legally admissible before the Workers’ Compensation Appeals Board in determining your disability benefits or right to future medical care.
The rules and regulations that apply to doctor selection are complex and each case must be evaluated on its own facts as no two are the same. This article should not be taken as legal advice that applies in your particular situation. Call the Law Offices of Marc Francis at (707) 664-9675 for a free consultation. You should work with an attorney focused solely on preserving your rights as an injured worker!