If you are injured on the job, one of the first questions you may have is whether you can continue seeing your Primary Care Physician (PCP) or if you must use a doctor chosen through the Workers’ Compensation system. In California, including for workers connected to areas like Sacramento, the answer depends on several factors, including whether you have pre-designated your doctor and how your employer’s insurance is structured. Understanding how medical treatment works under California Workers’ Compensation law can help you avoid delays or complications with your claim.
Key Takeaways:
- Most workers must begin treatment within an approved provider network.
- Pre-designation allows you to choose your own doctor in advance.
- Your PCP must agree to treat work-related injuries.
- Switching doctors must follow proper procedures.
- Unauthorized treatment may not be covered.
- Reporting your injury quickly is important.
Can You Choose Your Own Doctor for a Work Injury?
In most cases, injured workers must initially see a doctor selected by their employer or the employer’s Workers’ Compensation insurance provider, often through a Medical Provider Network (MPN). However, there is an exception. If you pre-designated your PCP before the injury occurred, you may be able to treat with that doctor right away. This requires written notice to your employer and confirmation that your doctor agrees to treat work-related injuries. Without pre-designation, you will likely need to begin treatment within the approved network.
What Is Pre-Designation and Why Does It Matter?
“Pre-designation” allows you to choose your own doctor in advance for workplace injuries. This must be completed before an accident. Your PCP must be your regular physician, agree to treat work injuries, and have your records on file. You must also notify your employer in writing. If these conditions are met, you can receive care from a doctor familiar with your history.
What Happens if You Did Not Pre-Designate a Doctor?
If you did not pre-designate, you will generally need to seek care within your employer’s MPN. After a period, often 30 days, you may request a change of physician within the network. In some situations, you may be able to switch outside the network if proper procedures are followed. Failing to follow these rules can lead to issues with your benefits.
Can You Switch Doctors During Your Workers’ Compensation Claim?
Yes, but there are limitations. You may switch to another doctor within the MPN. If there is a dispute about your condition, you may be evaluated by a Qualified Medical Evaluator (QME), who provides an independent assessment. Switching doctors outside of approved channels may affect coverage.
Will Workers’ Compensation Pay for Your PCP Visits?
Workers’ Compensation generally only covers authorized treatment. If you see your PCP without proper pre-designation or approval, the insurance company may not pay for those visits.
What Should You Do After a Workplace Injury?
Report the injury to your employer as soon as possible. Prompt reporting helps your claim move forward. You should also seek medical attention right away. Keeping records of your treatment and communications can support your claim.
Frequently Asked Questions:
Can I see my PCP immediately after a work injury?
Only if you have pre-designated your doctor before the injury.
What is a Medical Provider Network?
It is a group of approved doctors selected by your employer’s insurance.
Can I change doctors later?
Yes, usually within the network unless exceptions apply.
What if I go to my PCP without approval?
You may have to pay for those visits yourself.
Our Sacramento Workers’ Compensation Attorneys at Walters & Zinn, Attorneys at Law, Are Here to Guide You Through the Workers’ Compensation Process
Understanding whether you can see your PCP and how to follow California Workers’ Compensation procedures can make a difference in your recovery and your claim. Working with our Sacramento Workers’ Compensation attorneys at Walters & Zinn, Attorneys at Law can help you understand your rights and next steps. For a free consultation, call us today at 916-610-4706 or fill out our online form. With office locations in Folsom and Fairfield, California, we proudly serve clients in the surrounding areas.