Choosing a Doctor

After your initial evaluation, your employer or workers’ compensation insurance should notify you of your right to be treated by a different physician within the Medical Provider Network. They should also show you how to access the list of providers in the Medical Provider Network.

A doctor may treat you of your choice if a Medical Provider Network has yet to be established within 30 days from the injury’s report. However, it’s important to choose a doctor based on their specialty, expertise in treating a particular injury, or your condition.

If you choose a physical therapist as your treating physician, you can do so until you have reached the 24-visit cap authorized by your employer or your workers’ compensation insurance. If you’ve reached your cap and are approved for more treatment, you must choose another physician who is not a physical therapist to treat you. If you do not select another physician to treat you, your employer or insurance can choose for you.

Moreover, you cannot choose or change physicians if you are released from care by your treating physician. Being released from care means that your primary treating physician theoretically has determined that your condition has reached a permanent and stationary status. This means there is no need for continuing or future medical care.

Choosing a doctor from a Medical Provider Network is sometimes good. They are generally familiar with treating occupational illnesses and understand the workers’ compensation process. When people are injured at work, they want their doctor to treat them; however, it can be complicated. Sometimes a doctor will say you need a specific treatment. If they are not familiar with the workers’ compensation process, they may need to learn how to write the reports and adequately get the treatment approved.

There are many factors to consider when choosing a doctor in a Medical Provider Network. The first factor is whether the physician’s specialty suits your workers’ compensation injury type. For example, getting treatment for your leg injury is more complex from a doctor specializing in back injuries. You also need to find out if the physician is accepting new patients, if you can book an appointment in the allotted time frame, and if their office is accessible from home.

Most importantly, our Sacramento workers’ compensation attorneys would like you to read the reviews. Reviews will tell you whether the doctor is right for you and your case. We suggest you look past unfortunate factors in reviews, like the doctor showing up late to appointments or their lack of bedside manner. It would help if you looking for their response rate to appointments and information requests and how well they write reports.

The doctor may be good at treating your injury, but if they cannot write the needed reports, they may not be the best physician for your workers’ compensation case. Don’t be afraid to keep looking for a physician within your Medical Provider Network or call us at Sacramento Workers’ Compensation Attorneys, P.C. so that we can help.

If you dispute the diagnosis or treatment prescribed by your primary treating physician, you can get a second or third opinion. Continue receiving treatment from your physician while you go through the process. Be aware that you waive your right to get a second opinion if you do not make an appointment within 60 days of getting the list of doctors in your Medical Provider Network. If you decide to get a second or third opinion, it is your responsibility to do the following:

• Inform your physician that you dispute their diagnosis or treatment either orally or in writing;
• Select a new physician from your Medical Provider Network;
• Make an appointment with the new physician within 60 days; and
• Inform your current physician of the appointment date.

It is your workers’ compensation insurance’s responsibility to: 

• Provide you a list of physicians from your Medical Provider Network;
• Inform you of your right to request copies of your medical records to send to the “2nd opinion” physician;
• Contact your current physician so the current physician can provide copies of your medical records to you or your second-opinion physician before the appointment; and
• Please let (in writing) know that your new doctor has been chosen to provide a second opinion and why the first opinion is being disputed.

If they deem it appropriate, the physician will write a report offering an alternate diagnosis/treatment or stating why they agree with the first diagnosis. Copies of the report will be provided to you, your workers’ compensation insurance, and your current treating physician within 20 days of the appointment. If you disagree with the diagnosis or treatment plan after receiving your second opinion, you may seek a third opinion from a physician in your Medical Provider Network. The process of seeking a third opinion is the same. If you disagree with the third physician’s statement, you can file for an Independent Medical Review.