Workers' Compensation Toolkit

Return to Claims Kit Home

California Compliance



Physician Selection Cal. Lab. Code 4600(d), Rules 9780.1, 9783

Workers with health care coverage for conditions unrelated to work are allowed to predesignate their personal physician or a medical group before injury.

If there is a medical provider network (MPN), in most cases the employee will first be treated in the MPN after the injury, unless they predesignated.

If there is a health care organization (HCO), the employer or insurer that has a contract with an HCO must give employees a form prepared by the state Division of Workers’ Compensation, DWC Form 1194, to allow them to choose whether to enroll in the HCO. This form must be given to new employees within 30 days after date of hire and to current employees at least once a year.

If the employer or the insurer has a contract with an HCO, in most cases the employee will first be treated in the HCO after the injury, unless they predesignated.

If the employer or the insurer does not have an MPN and does not have a contract with an HCO, in most cases the claims administrator can choose the doctor who first treats the employee after the injury, unless they predesignated.

Other situations where the employee can choose who treats them right after injury even if he or she did not predesignate:

  • If the employer did not post required information about the workers’ compensation rights and has not offered treatment after learning about the injury, the employee can go to their personal physician right after the injury.
  • If the employer or the insurer sends the employee to treatment that is completely inadequate or refuses to provide necessary care, the employee can go to a physician of their choice. This does not have to be their personal physician.

DWC- 9783 Predesignation Of Personal Physician (Spanish)

 

DWC-9783.1 Notice Of Personal Chiropractor Or Personal Acupuncturist (Spanish)

Change of Physician

Choices depend on whether the employee is being treated in a medical provider network (MPN) or a health care organization (HCO) and whether they predesignated their personal physician.

  • If being treated in an MPN, after the first medical examination, the employee may switch to another doctor within the MPN, and may switch again whenever it is reasonable to do so. The employer or the insurer must give written information on how to do this and, starting January 1, 2014, offer services to help the employee find an available doctor. In most cases, the employee is not allowed to switch to a doctor outside the MPN.
  • If being treated in an HCO, the employee may switch at least one time to another doctor within the HCO. The HCO must give a choice of physicians within 5 days after the request to change. If covered by employer-provided health insurance, then 180 days after the injury or illness is reported to the employer, the employee may switch to a doctor outside the HCO.
  • If not covered by employer-provided health insurance, then 90 days after the injury or illness is reported to the employer, the employee may switch to a doctor outside the HCO. When switching to a doctor outside the HCO, the new doctor can be a medical doctor, osteopath, psychologist, acupuncturist, optometrist, dentist, podiatrist, or chiropractor*. The employee may switch again whenever it is reasonable to do so.
  • If not being treated in an MPN or HCO and the employee did not predesignate, the employee may switch to a new doctor one time during the first 30 days after the injury or illness is reported to the employer. However, the claims administrator is usually allowed to choose the new doctor. If the employee gave the name of their personal chiropractor or acupuncturist in writing before the injury, they may switch to their chiropractor* or acupuncturist upon request, after they first see a doctor chosen by the claims administrator. .
  • After 30 days, the employee may switch to a doctor of their choice if they still need medical care and the employer or the insurer still has not created an MPN. The new doctor can be a medical doctor, osteopath, psychologist, acupuncturist, optometrist, dentist, podiatrist, or chiropractor*.

 

*A chiropractor may not be the treating physician after the employee has received the maximum number of chiropractic visits. (If the date of injury is in 2004 or later, the employee is limited to 24 chiropractic visits, 24 physical therapy visits, and 24 occupational therapy visits for the injury (except for visits under the post-surgical treatment guidelines above), unless the claims administrator authorizes additional visits in writing. Cal. Lab. Code 4605(c))