Were you injured on the job in Fresno County? If so, you may have questions or concerns about who you should see for medical care. Can you choose your own doctor? Do you have to go to someone picked by your employer? The answers depend on several factors, including whether your employer is part of a medical provider network (MPN) and whether you predesignated a doctor. In this blog post, our Fresno County workers’ compensation lawyer explains the most important things to know about medical provider networks and your legal rights.
The California Department of Industrial Relations (DIR) defines a medical provider network (MPN) as a group of “medical service providers created to provide medical treatment for work injuries of employees in California.” MPNs are generally set up by self-insured employers or by workers’ comp insurers to employees who were hurt on the job. In California, MPNs must be approved by the Division of Workers’ Compensation (DWC). There are certain standards that must be satisfied. Among other things, medical provider networks must:
- Provide medical care in a manner that is fully consistent with the best practices in California; and
- Provide an injured worker with a clear opportunity to select a treating physician within the network at their first meeting.
In other words, an MPN is effectively a network of physicians of which your employer is a part. If you are injured on the job in California, you will generally have to receive your medical care from one (or more) doctors within your employer’s network. Many MPNs are of a significant size, meaning a number of different medical providers are available. Still, if you are covered by an MPN, you are restricted to choosing an in-network provider.
Exception: You May be Eligible to Predesignate a Physician in Some Circumstances
There is an important exception to California’s MPN regulations. In some cases, workers may be able to presignate an out-of-network provider to handle a future workplace accident. There are very specific rules and procedures that must be met when to select your own out-of-network doctor. More specifically, a worker must meet the following three criteria:
- Predesignation must occur ahead of time. You cannot choose an out of network doctor after an accident in the workplace has happened. You must “pre” designate your own physician.
- Your out of network doctor has to agree to the arrangement. There is a form that must be signed and submitted by your out of network doctor to be valid.
- You cannot have employer-sponsored health insurance coverage. If you are on your employer health coverage, you cannot predesignate in California.
Joseph C. Yrulegui is an experienced California workers’ comp lawyer. If you have any specific questions or concerns about MPNs, we are here to help. Give us a call now or connect with us online to arrange your strictly confidential, no obligation case evaluation. We represent injured workers throughout Fresno County, including in Fresno, Clovis, Parlier, Kerman, and Coalinga.