When you’re hurt on the job in California, the doctor who treats your injuries will play a vital role in your recovery as well as the workers’ comp benefits you’ll receive. The wrong doctor might provide inadequate treatment, send you back to work too soon, or downplay your injuries, resulting in a denial or reduction of your benefits. Fortunately, in California you can change doctors if you’re not satisfied with the medical care you’re receiving. But you must follow the rules for making that switch, or your employer’s insurance company may refuse to pay the medical bills.

The specific procedures for changing physicians depend on how you choose the first treating doctor and whether the insurance company has a managed provider network (MPN) or health care organization (HCO) for treating work injuries. Read on for details.

Choosing the Initial Treating Doctor for Workers’ Comp in California

Your selection of a treating doctor can be one of the most important decisions you make in your workers’ comp case. Your physician will diagnose your medical condition and its connection to your job, recommend treatment and refer you to specialists, take you off work or restrict your job duties if that's needed during your recovery, and decide whether you have permanent disability as a result of your work injury.

In California, you may choose your personal physician or a qualified medical group as your treating doctor for workers’ compensation, but only if:

• your employer provides regular health care coverage, and
• you have already given your employer written notice (known as “predesignation”) that you want your personal physician to treat you for any future work injuries.

If you haven’t predesignated your doctor, your initial treatment must generally be with a doctor chosen by the insurance company or within the insurer's network of doctors.

Procedures for Changing Your Treating Doctor in California

If you feel that you aren’t receiving proper medical care, or you don’t agree with your doctor’s opinions and recommendations, you may switch to another physician under the procedures and timing that apply to your situation.

When You Predesignated a Personal Physician

If the insurance company has an MPN or HCO, you may switch from your predesignated doctor to a network physician at any time. If there’s no MPN or HCO, the rules depend on when you want to make the move:

• During the first 30 days after you reported your injury, you may change doctors once, but the insurance company will usually select your new doctor.
• After 30 days, you may transfer to a doctor of your choosing. You must notify the insurance company of the change and provide it with your new doctor’s name and address.

When There Is a Managed Provider Network

If the insurance company has an MPN, you may change doctors any time after your first examination. However, you typically must treat with a network physician or provider for the duration of your workers’ comp claim.

When There Is a Health Care Organization

If the insurance company has an HCO, you may request a change to another in-network doctor, but the HCO will assign you the new provider. You may switch to a doctor outside the HCO after a waiting period that starts when you reported your injury: 90 days if you don’t have regular health insurance through work, or 180 days if you do have employer-provided coverage.

When You Do Not Have a Predesignated Doctor, MPN, or HCO

If you did not predesignate and the insurance company doesn’t have an MPN or HCO, the rules for switching doctors are essentially the same as when you’ve been treating with your predesignated doctor: During the first 30 days after your injury report, the insurance company typically chooses the new physician. After that, you may switch to a medical provider of your choosing, as long as you notify the insurer about your new doctor.

Where Can I Get More Information About California Workers' Comp Rules?

The California Division of Workers' Compensation website offers helpful information about its rules and procedures, including brochures, guides, and forms. But if you’ve having trouble getting the medical care you need, it might be time to contact a workers’ comp lawyer. An attorney who’s experienced in this area can guide you through the process of changing doctors and getting approval for treatment if the insurance company is balking. A lawyer may also be able to recommend a good treating doctor who knows how to deal with the workers’ comp system.