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Doctors and Treatments Affect Your California Workers’ Compensation Benefits

Workers’ compensation lawyers in Orange, CA help you get the medical treatment you need to recover

Invictus Law, P.C., with offices in Santa Ana and Ontario, helps injured workers in Orange, Riverside and San Bernardino counties get the medical care they need to treat workplace injuries and illnesses. Under state law, each injured worker eligible for workers’ compensation benefits is entitled to medical care that is “reasonably required to cure or relieve” a work-related injury. Our legal team’s goal is to help you overcome obstacles.

You can use personal physician or doctors of your choice in certain situations

Each worker has an opportunity to use his or her own doctor in the case of an on-the-job injury only if the doctor’s identifying information was given to the employer prior to the injury. If no pre-designation exists, using a doctor of your own choice is still possible under certain conditions:

  • If your employer did not post required information about workers’ compensation rights and did not offer treatment after learning about your injury
  • If your employer or the claims administrator sends you for treatment that turns out to be insufficient or if neither give you the care you need

If either of these two conditions exists, contact an attorney immediately so you can avoid a potential dispute that could cost you valuable workers’ compensation benefits.

Using your employer’s Medical Provider Network (MPN) to treat your injuries

If your employer or insurer uses a medical provider network (MPN), it must give you information about it in writing. You must use a physician from that network for your medical care.

An attorney can help resolve disagreements about medical treatment

You can challenge the medical treatment you receive if you feel it’s not adequately serving you. The process you follow depends on whether a physician within an MPN has been treating you. If seeing a second doctor within the network does not result in an agreement, you can get up to two more doctors’ opinions within the MPN. After the claims administrator provides you with a list of doctors, you have to see one or two within 60 days. If you can’t reach an agreement with these doctors, we can help you arrange for an independent medical review with the California Division of Workers’ Compensation. If that doctor agrees with you, you can seek treatment outside of the MPN.

If you did not seek treatment through an MPN or healthcare organization, you must send a letter stating your disagreement to the claims administrator within 30 days of receiving the medical report. However, you can choose to let a qualified workers’ compensation attorney handle this for you. We can write and file that letter, meeting the 20-day deadline. Such a challenge results in a medical evaluation by a panel.

The claims administrator makes decisions through a utilization review process

The claims administrator approves treatment through a utilization review, but a qualified doctor evaluates your recommended treatment. If your condition is urgent, decisions could be made within 72 hours to promptly address your medical needs. If your condition is not urgent, the decision should not exceed five working days after the administrator receives the physician’s request for authorization. Sometimes, though, the administrator may need more time and more information, and the decision could take up to 14 days.

These decisions can often seem off base, because the physician performing the utilization review has not examined you. When disagreements about your necessary treatment arise, you need a skilled workers’ compensation attorney to advocate for the medical care you require to recover from injury or illness. We can also help you understand how preexisting conditions may affect your eligibility and benefits.

Find out more about workers’ compensation medical care in a free initial consultation

Invictus Law, P.C. offers injured workers proven methods to get the workers’ compensation benefits and medical care they need to recover. Call us anytime at (949) 287-5711 or use our online contact form to tell us about your situation and set up an appointment. We offer flexible hours.

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