What Happens When You and the Workers’ Compensation Doctor (MPN) Don’t Agree?
Written & Edited By: Cecily Johnson, Legal Assistant & PR Manager
You were hurt on the job, and you’ve been off work for a while. Initially, the doctor you’ve been seeing through your company’s medical provider network (MPN) seemed okay, but now you’re no longer convinced that they have your best interests at heart. So, what are your options?
California Law Gives You Options But…
Although it depends on the specific circumstances of your case, generally speaking, California law gives you some options. However, it’s critically important to take action without delay if you do have a disagreement about your workers’ compensation claim with your MPN doctor. Failure to take timely legal action can cost you your rights, your financial security, and your future.
Option 1: Ask for Second (and Third) Opinions & Request an IMR
If you disagree with the MPN doctor’s plan for your care or your diagnosis, you have the right to ask for a second (and third) opinion from other doctors in your company’s MPN. If you still believe that your treatment plan isn’t what it should be, you can then ask for an Independent Medical Review (IMR).
Option 2: Request a Review by a QME
If you disagree with any other part of the MPN doctor’s assessment, you will have to request a review by a qualified medical examiner (QME). This includes your MPN doctor’s assessment of:
- Any permanent or temporary disability rating
- When you are fit to return to work in any way, including light-duty assignments
- What kinds of reasonable accommodations you may need to do your job.
In addition, you may need a medical exam by a qualified medical examiner if your claim is denied or unfairly delayed for some reason.
Timely Legal Action is Essential
Navigating through your complex workers’ compensation claim can be tricky! Especially, when deadlines are critical to your physical and financial wellbeing. However, you don’t have to do it alone. An experienced advocate can help you learn more and guide you in the right direction.
Division of Workers’ Compensation – Injured worker information. (n.d.). Answers to frequently asked questions about workers’ compensation for employees. DWC FAQs for employees. https://www.dir.ca.gov/dwc/WCFaqIW.html#ReturnToWork.