When you’re injured at work, one of your first concerns is getting the medical care you need. In California, however, that doesn’t mean heading to your primary care physician. Instead, the workers’ compensation system may require you to choose your doctor from a Medical Provider Network (MPN).
A Medical Provider Network is a list or grouping of doctors and medical providers selected to treat on-the-job injuries. The worker’s employer or insurer designates the providers on the MPN, but the California Division of Workers’ Compensation (DWC) must certify the list. If your employer has an approved MPN, you must generally use it for your care.
Do you have any choice about your own doctor?
The existence of an MPN doesn’t mean you lose all autonomy in your own care. How much personal choice you have, however, depends a lot on whether or not you have a standing agreement with a physician regarding workers’ comp claims.
If you have health insurance, an established relationship with a personal physician and that physician has agreed to handle any work-related injuries, you can complete a “Pre-designation of Personal Physician” form and submit it to your employer. So long as that is on file before your injury occurs, you can use that doctor.
If you do not have a pre-designated personal physician, you must generally see the physician chosen by your employer for the initial 30-day period after your injury. After that 30-day period elapses, you can elect to choose another physician from the MPN list. You also generally enjoy the right to ask for a second (or even third) opinion, if you so choose.
In addition, there are some broad exceptions to the rules regarding MPNs. If your employer doesn’t have a certified MPN (or doesn’t provide you with the list of providers on their MPN as required), you must initially use their chosen physician but can then transfer your care to any doctor who agrees to handle it after the initial 30-day period elapses.
In practical terms, most injured employees will have to choose from a physician on their employer’s list, but you never lose the right to challenge inadequate or denied care. If your workers’ comp claim is not proceeding as it should, it may be time to speak with an attorney.
