Can I Choose My Workers’ Comp Doctor in California?

Technically, yes, you can choose your workers’ compensation doctor. But as with many things in California workers’ comp, there are specific rules that apply for different situations. If you care about seeing a doctor you know and trust after getting hurt or sick at work, it’s important to know what the law says about when it comes to claiming workers’ comp.

How to choose your California workers’ comp doctor

When you first get hurt on the job, you can see any doctor you want if you need emergency care. But after that, whether you can see your own doctor for a workplace injury or illness comes down to timing. You actually need to take a few steps before a workplace incident occurs.

Specifically, California workers’ comp law lets you see your own doctor if you’ve predesignated them.

Predesignate your doctor first

To assign that predesignation, you need to provide your employer with a written notice that tells them two things. First, it needs to notify them that you want your personal doctor to see you for work-related injuries and illnesses. Second, it needs to provide your doctor’s name, business address, and confirmation that they’re willing to see you for work injuries.

You can use DWC Form 9783 from the ​​California Department of Industrial Relations (DIR) to predesignate your doctor of choice.

Some things to know about predesignation:

• You need to have your own medical insurance in place for non-work related injuries. It’s okay if that coverage is through your employer.

• You can designate a doctor of medicine (MD), doctor of osteopathy (DO), or a medical group. You can separately predesignate your personal chiropractor or acupuncturist, too.

• You need to have seen that doctor at least once before.

• The doctor needs to have your medical records on file.

• The doctor needs to agree in advance to treat you for workplace injuries and illnesses.

Here’s a full guide on predesignating your workers’ comp doctor.

Can you choose a doctor if you don’t predesignate?

If you haven’t already named your preferred doctor with your employer and you get hurt or sick at work, your medical care options depend on what your employer has set up.

They may have already established a:

• Medical provider network (MPN): This is a group of doctors that your employer chooses to treat workplace incidents. The California Division of Workers' Compensation (DWC) has to approve MPNs before they’re established. If your employer has an MPN, you should get a list of all of the doctors in that network. Those are your options in terms of who to see.

• Healthcare organization (HCO): The DWC certifies HCOs, which manage medical care on behalf of the employer and the injured employee. You’ll get assigned to a doctor within the HCO.

If your employer doesn’t have an MPN or HCO, the claims administrator overseeing your workers’ comp case has the right to pick who you see — at least at first. You may have the option to change doctors (more on that in the next section).

This all applies if your employer has complied with workers’ comp laws. If they haven’t posted the required information or they don’t offer treatment after you tell them about your workplace injury, for example, you may have the right to choose your own doctor. This can get complicated, so if you think your employer hasn’t followed the rules, talk to a workers’ comp lawyer for help getting the medical care you want.

When you can change your workers’ comp doctor

If you didn’t predesignate your own doctor, you still have some options for finding a medical care provider that you like and trust. Your options — and how quickly you can use them — depend on what your employer already has in place.

If your employer doesn’t have an MPN or HCO: You can switch doctors one time within the first 30 days. After 30 days, as long as your employer hasn’t set up an MPN, you can switch to a doctor of your choice, provided they’re within what the DIR calls “a reasonable geographic area.”

If your employer has an MPN: If you don’t like the doctor you get assigned to, you can switch to another doctor in the MPN after your first appointment. You can continue switching to other doctors in the network as much as is reasonable.

If your employer has an HCO: You can switch to another doctor in the HCO if you’re not happy with the first physician you see. That said, state guidelines only allow you to switch “at least one time” within the HCO, so you should choose the next doctor carefully.

For injuries that require months of recovery, you may eventually be able to choose a doctor outside the HCO. As long as you have employer-provided health insurance, you can switch to a doctor outside the HCO 180 days after you report your injury or illness to your employer. If you have your own private health insurance that you pay for on your own, you can switch after 90 days.

What to do if you disagree with your doctor

No matter which doctor you see, you might not agree with their evaluation of your condition or your ability to return to work. There’s a process in place that allows you to get a second opinion, but it varies depending on whether you have a workers’ comp lawyer or not.

If you don’t have a lawyer

1. Send QME Form 105 to the DWC, which will randomly assemble a panel of three qualified medical evaluators (QMEs).

2. Receive a list of three QMEs options within 20 working days.

3. Choose a doctor from the list and make an appointment within 10 days of the date printed on the panel list.

If you don’t pick a doctor, the insurance will pick on for you.

If you do have a lawyer

You have more options and the process of getting a second opinion is much simpler if you’re working with a lawyer. When you have legal representation, your claims administrator has to work with your lawyer to pick the doctor you see next. This doctor is called the agreed medical evaluator (AME). You have access to far more potential doctors through this route. Here’s what else a workers’ comp lawyer can do.

Get help managing your medical care

If it’s important to you that you see your own doctor after a work injury, the best thing you can do is predesignate them with your employer now.

The next best thing you can do is loop in a workers’ comp lawyer. They’re legal professionals who are trained to help you get access to the best medical care for your specific needs. An experienced lawyer has a network of medical experts that they work with and trust. They also help you maximize your payments and negotiate a fair settlement. Working with a lawyer also doesn’t cost you anything out of pocket.

If you’re curious to explore what a good workers’ comp lawyer could do for you, Atticus is a California-based law firm with local workers’ comp attorneys across the state. Our team can answer your questions and connect you with a lawyer who’s a fit for your case. Start by taking our quick workers’ comp quiz and our team will reach out. You can also call us at the number below.

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Related resources:

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