When you are injured at work, it’s important to get the right medical care. California’s workers’ compensation law has specific rules, however, about which doctor you may see and when you may switch doctors. Below, we will walk you through everything you need to know, including common questions, exceptions, procedures, and legal protections you should be aware of.
The Legal Foundation: Workers’ Compensation and Your Medical Rights
California’s workers’ compensation system is a state-mandated insurance program that provides medical treatment, wage replacement, and other benefits to employees who suffer work-related injuries or illnesses. A crucial part of this system involves medical treatment rights, and central to those rights is the ability to select or change your treating physician.
However, that freedom is heavily conditional and depends on whether your employer uses an MPN (Medical Provider Network) or an HCO (Health Care Organization). These designations significantly influence your options for care.
Doctor Choice in California Work Injuries
Let’s break down the core elements of doctor selection within the EAV model:
| Entity | Attribute | Value |
|---|---|---|
| Doctor Selection | Network Type | MPN, HCO, Non-network |
| Initial Care Timeline | Legal Window | First 30 days post-injury |
| Patient Autonomy | Pre-Designation | Requires written notice before injury |
| Treatment Disputes | Conflict Resolution | Independent Medical Review (IMR) |
| Network Absence | Default Policy | Own doctor after 30 days |
| Emergency Cases | Provider Freedom | Any licensed provider is allowed |
Each of these dimensions affects your rights and obligations, and understanding them is essential for both compliance and care quality.
Employers Have Some Say in Which Doctor You See
When you are injured at work, your employer provides your medical care, typically through your employer’s workers’ compensation insurance. Because they are paying for the care, they have some say in which doctor you may see for your injury or illness. In California, most employers have contracted with a Medical Provider Network (MPN) or a Health Care Organization (HCO), and you will have to see a doctor in one of those networks.
What’s an MPN or HCO?
- MPNs are doctor networks selected and approved by your employer’s insurance provider. They specialize in treating workplace injuries.
- HCOs are similar but also offer managed care options to control treatment costs and timelines.
If you are directed to an MPN or HCO, your treatment must begin within that group. If you wish to change providers, you’ll need to do so within the same network unless further steps are taken.
You May Be Able to Change Your Doctor
If you are not happy with the care you receive from your initial doctor, California law does allow you to change doctors. If your employer has an MPN or HCO, you will probably need to pick your new doctor from this same group.
If you are still unsatisfied, you may be able to choose your doctor outside of an HCO after a waiting period. If your employer is in the MPN system, you may be able to request an “Independent Medical Review (IMR)” from an outside doctor. If your employer has neither an HCO nor an MPN, you may be able to choose your doctor after 30 days.
IMR Explained
An IMR is a third-party evaluation process in which a neutral, state-approved doctor evaluates the appropriateness of your treatment or the denial of care. It’s your legal right when there’s a disagreement over the medical necessity of proposed treatment.
How to initiate an IMR:
- Obtain the IMR application form (usually included with the claims administrator’s denial).
- Submit your application within 30 days.
- Await a decision within approximately 45 days.
This process is especially useful if your treating doctor refuses to approve diagnostic imaging, surgery, or extended therapy that you believe is necessary.
Under Some Circumstances, You Can See Your Primary Care Doctor
If you have your doctor, you would probably prefer seeing your doctor over one you have never met. But that option may only be available to you when:
- You have health insurance for non-work injuries and illnesses.
- Your doctor agreed to treat you for work injuries before your accident happened.
- Before your accident, you gave your employer notice in writing that you would be using your personal doctor for workplace injuries.
If you did not follow these steps, you will probably have to see the doctor in the medical provider network your employer has set up for your initial visit.
Emergency Medical Situations and Exceptions
In urgent cases, such as head injuries, fractures, or significant blood loss, you may receive immediate care from any licensed provider regardless of network restrictions. California Labor Code Section 4600 outlines this exception to ensure prompt medical intervention.
This bypasses MPN/HCO restrictions until the emergency is stabilized, after which network-based rules resume.
What If My Employer Doesn’t Have an MPN or HCO?
If your employer lacks both an MPN and an HCO, and you did not pre-designate your doctor, you are legally required to accept the employer’s selected doctor for the first 30 days following the injury. After that:
- You may select any licensed physician in California.
- You may also switch doctors without needing IMR as long as the employer doesn’t introduce a network retroactively.
Comparative Insight: California vs. Other States
Unlike some other states, California has strict procedural layers before an injured worker can opt for non-network doctors. For example:
- Texas: Allows more flexibility post-injury and provides state-level ombudsman services.
- New York: Requires pre-authorization for most procedures, even within the network.
- California: Focuses heavily on IMR and pre-designation but supports multilingual access and protects emergency care rights.
Real Case Scenario: Changing Doctors and Winning IMR
Consider a construction worker in Van Nuys who suffered a knee injury. The MPN-assigned doctor denied MRI scanning, citing soft tissue strain. The worker, feeling unheard, requested an IMR. Within six weeks, an external physician approved the MRI and recommended surgery, showing the power and impact of the IMR process when properly invoked.
FAQs About Workers’ Comp Doctor Rights in California
What if I never submitted a pre-designation form?
Then you’ll need to start your care within the MPN or HCO and follow the procedures to switch if needed.
Can I go outside the network if I don’t like the available doctors?
Only after completing network options, applying for IMR, or waiting for the 30 days (if no network exists).
What if my employer’s doctor misdiagnoses me?
You may request a second opinion within the network and escalate to IMR or AME (Agreed Medical Evaluator) if a legal dispute arises.
Can my chiropractor be my primary doctor?
Not unless agreed upon in advance and within the network. Limits apply to the number of allowable chiropractic visits.
Let Us Help You Today
If you’re unsure about your medical rights under California workers’ compensation laws or believe your care has been compromised, don’t wait.
Contact the Law Offices of Hussain & Gutierrez at 888-997-3701 or visit hussaingutierrezlaw.com for a free consultation.
- Walk-ins welcome
- Se habla español
- We speak Sinhala, Tamil, Gujarati, Hindi, and Urdu
You don’t have to navigate the complex workers’ comp system alone. Our attorneys are here to advocate for your rights and ensure you receive the care and compensation you deserve.
