I Was Injured At Work in California, Can I Choose My Doctor?

Wiesner English, P.C.

As with many things in law, the answer is, it depends. The more cynical answer is, yes, but the insurance controls the doctors on the list. So, how good is that list going to be?

We call these lists Medical Provider Networks or MPNs. Each workers’ compensation insurance carrier, administrator, or self-insured employer (we will this group the “insurance” as a short hand) has the right to establish an MPN. They do this so they can control costs and who can treat injured workers. Also, medical providers often must cooperate with the insurance if they want to be part of the MPN. If not, they risk being booted out of the MPN. Another instance, unfortunately, of the insurance having the upper hand in our broken system.

While there are ways to prove that the MPN is invalid and/or unenforceable (more on this below) such that you can ACTUALLY choose your doctor, this is the exception to the rule. Most of the time, an injured worker is stuck with the doctors the insurance wants you to see. Picking from this list on your own can be dangerous and you may end up with a doctor more worried about what the insurance thinks than your health!

About a year ago, our state assembly proposed a bill to negate this unfair control. The proposal was to create “state-wide” MPN that could include any treater who voluntarily registered. This was to allow greater access to treatment while taking unfair control out of the hands of the insurance. Of course, the insurance industry cried foul. They complained a state wide MPN would raise costs (without evidence to support that claim). Unfortunately, a new version of the bill has been proposed that adds MORE restrictions to even obtaining information about the proper MPN. An attempt to help injured workers’ is now being used against them. Few Applicant Attorneys are surprised by this…

However, there is some hope. It is possible to invalidate and MPN or prove it’s unenforceable! It all comes down to “access standards.” Meaning, generally, the MPN must have a certain number of doctors in each specialty to treat typical work injuries. While, it gets a LOT more complex from there (e.g., the “rural rule”, the “primary treater rule”, etc.) WE can review your MPN with you and help you identify the better doctors in your network or, possibly, help you get out of an invalid MPN all together. Call today for a free consultation!

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