After a workplace injury in California, your access to medical care is shaped by specific workers’ compensation laws designed to control costs and shape treatment. While the system does not give you unlimited freedom to visit any doctor you want, it also recognizes your right to speak up if you disagree with your care or diagnosis.
Workers in California are allowed, under well-defined rules, to challenge the opinions of the workers’ compensation medical providers, seek second opinions, or request independent medical reviews in certain circumstances. Contact our work injury lawyer in Los Angeles for a free consultation.
The Role of the Primary Treating Physician (PTP)
The primary treating physician (PTP) is the main doctor who oversees your medical care after a workplace injury under California’s workers’ compensation system. If you don’t already have a predesignated doctor listed with your employer, you usually have to see a physician within your employer’s Medical Provider Network (MPN). The employer or their insurance provider manages this list of approved providers.
Sometimes a worker who already has a regular family doctor can fill out paperwork before any injury (predesignation), so that their regular doctor is the one handling everything if an accident occurs at work.
How to Seek a Second Opinion in California Workers’ Compensation
California workers have the right to question a treating physician’s decision if something doesn’t feel right with their care. Here’s how this process typically works.
Tell Your Employer or Insurer That You Disagree
To begin the process of getting a second opinion, you must inform your employer of their insurer in writing that you disagree with what your doctor has recommended or diagnosed.
Find the Doctor for Your Second Opinion
You’ll need to choose a different provider from the same Medical Provider Network (MPN) where you started treatment. Your employer is required to provide you with a fresh local list of appropriate doctors (including the correct types of specialists), and it’s up to you to make an appointment within 60 days of receiving the list.
You’ll also need to let your employer or insurer know when that appointment is scheduled. If you miss this window, your right to a second opinion may disappear.
Keep Up with Treatment During the Process
While you wait to see the new doctor, or while second and third opinions are sorted out, you are usually required to continue your current medical care; it is important not to stop following treatment advice unless another doctor tells you.
What Happens if You Still Disagree – Third Opinions and Independent Review
If the second-opinion doctor’s recommendation still doesn’t answer your concerns, you are allowed to ask for a third opinion, again consulting the MPN and following the same steps with scheduling and notification. You have a 60 day time limit here, too.
Written Opinions and Next Steps
Doctors providing second or third opinions must issue a detailed written report within 20 days. They can order tests, suggest alternate diagnoses, or lay out new treatment plans, and their report is shared with you, your employer/insurer, and the original treating physician. At this point, you may proactively choose to transfer your care to any of the doctors you’ve visited.
What if You Still Don’t Agree?
If the entire process still doesn’t fully address your own medical needs or settle your concerns, the door remains open for requesting an Independent Medical Review (IMR) through California’s Administrative Director.
Knowing these steps can give you some peace of mind that disagreement isn’t the end of your options. If you have any questions, don’t hesitate to contact our team today to schedule a free consultation with our Los Angeles personal injury attorney.