Medical care is one type of workers’ compensation benefit that should cover the expenses you need for diagnosing and treating a work-related illness or injury. If you did not predesignate a doctor or physician, your employer should arrange your medical treatment within 30 days from when you reported the illness or injury.
You cannot go to your chosen physician if you did not predesignate one before the illness or injury. You must first go to the employer’s chosen Health Care Organization (HCO) or Medical Provider Network (MPN) for initial consultation. In some cases, the workers’ compensation insurer names an accredited HCO or MPN. If you do not like the physician treating you, you may be able to switch under varying circumstances.
When can I change my doctor?
Your ability to change doctors depends on whether you received your initial treatment from an HCO, MPN, or predesignated physician. Here are the basic guidelines:
- MPN: If you received treatment from a physician from your employer’s MPN, you could change them more than once. The second and third physicians must also come from the employer’s MPN. If you still do not agree with the third physician’s diagnosis or treatment, you can apply for an independent medical review. Once the review moves in your favor, you can choose a doctor outside of the MPN.
- HCO: If your employer has an HCO, you can switch to another physician within the HCO at least once. You may choose an outside doctor if your employer provides health insurance, but only 180 days after you reported the illness or injury. For employees without employer-provided health insurance, the waiting period is 90 days.
- Predesignated physician: If you predesignated your physician, you could still change them, provided you make the switch within the first 30 days after reporting your injury or illness. Your predesignated physician could refer you to a doctor or you could select one in the MPN or HCO and change them according to the parameters above.
The same holds true when your employer or insurer does not have an established MPN or HCO. An insurance provider may only assign a doctor to you within the first five days of your request for medical attention, after which you can choose your own doctor and change them once within the 30-day timeframe.
You should be comfortable with your doctor
One of the reasons a person would go to another doctor is to get a second opinion. However, you should also feel comfortable with the person diagnosing and treating you. After all, trust is the basis of a relationship between a doctor and a patient.
