Most California workers do not get to choose any doctor they want after a job injury. The good news: you do have meaningful choices inside the system, and one big choice you can make before you ever get hurt.
The Default Rule: The Employer Controls the First 30 Days
If your employer has set up a Medical Provider Network (MPN), which most California employers have, the carrier picks the first doctor you see after your injury. You generally do not get to pick freely off the street.
For the first 30 days after you report the injury, the employer-selected physician runs your care. After 30 days, you can switch to any other doctor within the MPN, and you can change once more after that if the second doctor is not working out.
What Is an MPN?
A Medical Provider Network is a list of doctors the carrier has pre-approved. By law, an MPN must include enough providers in your geographic area, must include occupational medicine specialists, and must allow second and third opinions if you disagree with the treating doctor.
Ask your employer for the MPN list. They are legally required to provide it. If they cannot or will not, that is one of the situations where you may be allowed to treat outside the network.
The Power Move: Predesignation
This is the single most important workers' comp tip most California workers have never heard. Before you get hurt, you can name your personal doctor as your designated workers' comp physician. If you do, and the injury happens, you go to your own doctor, not the MPN.
To predesignate, all of the following must be true:
- Your employer offers group health coverage
- The doctor is your regular treating physician who has your medical records on file
- The doctor agrees in advance to treat you for work injuries (you may need to ask them)
- You submit the predesignation in writing to your employer before any injury
Most workers never do this. The ones who do have a noticeably easier path through the system because they are treated by a doctor who knows them and is not financially tied to the insurance carrier.
When You Can Go Outside the MPN
- The employer failed to properly notify you about the MPN at hire and after injury
- The employer denied liability (you can self-procure care until the denial is resolved)
- An emergency: go to the nearest ER, regardless of MPN
- The MPN does not have an appropriate specialist within a reasonable distance
What If You Do Not Trust the MPN Doctor?
This is the most common complaint we hear. MPN doctors are paid by the carrier, and some are noticeably more conservative about restrictions, treatment authorizations, and disability ratings.
Your options:
- Use the MPN's second-opinion process
- Request a third opinion if the second opinion still does not resolve the disagreement
- If a disputed medical issue remains, request a Qualified Medical Evaluator (QME) panel
- If you have an attorney, the case may proceed with an Agreed Medical Evaluator (AME) instead
The QME and AME System
When the treating doctor's opinion is contested, California uses an independent evaluator system. Unrepresented workers get a QME selected from a state-issued panel of three. Represented workers and the carrier can agree on an AME, an Agreed Medical Evaluator, whose opinion typically carries more weight because both sides chose them.
The Bottom Line
You probably cannot just walk into your favorite doctor's office and have them bill workers' comp, unless you predesignated. But you have more control than the carrier wants you to think. Use the MPN list, switch doctors when you need to, and escalate to QME or AME when the medical opinion is wrong.
Hurt on the job in Los Angeles? Talk to a real workers' comp attorney. Free, confidential, in English, Español, or Հայերեն. Call (747) 777-5977 or send a message.