WORKER'S COMPENSATION PROVIDER RULES FOR California
- State-Specific Rules for Selecting Medical Providers:
- If the insurer or self-insured employer has established a Medical Provider Network (MPN), the employee can select a treating physician directly through the MPN. If there is no established MPN, then pursuant to Labor Code 4600(c)......after 30 days from the date the injury is reported, the employee may be treated by a physician of his or her own choice or at a facility of his or her own choice within a reasonable geographic area. A chiropractor shall not be a treating physician after the employee has received the maximum number of chiropractic visits allowed (24 visits) by subdivision (d) of Section 4604.5. Pursuant to Labor Code 4600 (d)(1), an employee can designate a doctor outside of the MPN if they do so prior to having a work related injury under the following provisions: If an employee has notified his or her employer in writing prior to the date of injury that he or she has a personal physician, the employee shall have the right to be treated by that physician from the date of injury if the employee has health care coverage for non-occupational injuries or illnesses on the date of injury in a plan, policy, or fund as described in subdivisions (b), (c), and (d) of Section 4616.7. For purposes of paragraph (1), a personal physician shall meet all of the following conditions: Be the employee's regular physician and surgeon, licensed pursuant to Chapter 5 (commencing with Section 2000) of Division 2 of the Business and Professions Code. Be the employee's primary care physician and has previously directed the medical treatment of the employee, and who retains the employee's medical records, including his or her medical history. "Personal physician" includes a medical group, if the medical group is a single corporation or partnership composed of licensed doctors of medicine or osteopathy, which operates an integrated multispecialty medical group providing comprehensive medical services predominantly for non-occupational illnesses and injuries. The physician agrees to be pre-designated.
California Claim Kit
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