I have a California 2002 workers' compensation case, my case reached a settlement and I have health care for life. The Doctor ,however, who provided me medical care for the past six years gave me a notice, that he will no longer be able to continue my medical care, because the insurance does not want to pay the costs of medical care and already owes to much. Now I don't know what I have to do because he is the one who prescribes me my medical prescriptions. I have no money to pay another doctor to treat me. I'm confused, can someone please give me some legal advice. Thank you for your time.
1) Get an attorney
2) write the adjusting agency and request a list of treating physicians in your area in their MPN
3) pick a new treating physician from the list and make an appointment.
4) if the adjusting agency does not promptly approve the new physician, see #1
Your doctor didn't end your medical treatment. You still have an Award for medical treatment. He just decided not to do WC anymore.
Your doctor does not have to continue to practice (he could retire or move away); He does not have to continue to see workers' comp patients (getting treatment authorized has become impossible); He does not have to continue as your doctor.
Your insurance company has the right to set up a medical provider network (MPN) and if you want them to pay for treatment, you have to select a doctor from within the MPN. Contact the insurance company and find out how to access the MPN on-line. Pick a doctor and see if he's willing to see you.
If you had an attorney when you settled your case, return to that attorney. Other wise, it's going to be tough to find a lawyer at this stage of your case.
Unfortunately right now many doctors are getting out of workers' comp because of all the red tape and the fact that their bills are not getting paid. What you are left with in the workers' comp system is some (most) doctors who are less desirable. This is very sad for you and all injured workers.
Since your current doctor no longer wants to treat you and you cannot afford your medications on your own, you will need to select a new doctor ASAP so there is the shortest possible interruption in receiving your medications.
The first step is to find out if there is a Medical Provider Network (MPN). Call the adjuster and find out if there is a MPN. If the adjuster does not answer the phone, leave a message then call back and try to get a real person on the line. All you need to know is how to access the MPN and you probably can do this online. Call the doctors in the MPN and see if they still take workers' comp (Probably many wont).
If there is no MPN you are free to treat with any doctor that takes WC. Once you select a doctor, send a written note to the Adjuster that you select "Dr. so-and-so as" your "Primary Treating Physician." In this note also ask the Adjuster to authorize "Dr. So-and-so" to treat you. Also call the adjuster with the same information.
Since I don't know the body parts injured, it is difficult to recommend a doctor but here are some choices you may look for in the MPN:
Dr. Robert McClure (family practice -- part of a good group and probably my top choice if you have multiple issues/body parts)
Dr. Guy Gottschalk, MD (Occupational Medicine)
Dr. Cliff Bernstein (pain management)
Dr. Dana Johnson (Kaiser Occupational Medicine)
Dr. Paul Umof, (ortho/family practice)
Dr. Gary Zagelbaum (internal/heart)
Good Luck to you!
Do you have an attorney? If so, I recommend you discuss this with him/her. If not, you can still consult with an attorney. You may be able to go to an expedited hearing on the issue or perhaps treat outside the network, if this is a network doctor refusing treatment.
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Everyone has provided sound advice. The short answer is get a copy of the MPN doctors list and select a new doctor. Write the insurance carrier and advise of the change and ask them to provide WRITTEN authorization and copies of your medical records to the new doctor. Choose carefully, and speak to your WC attorney if you have one. Good luck.
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