Employees who have any healthcare insurance for injuries or illnesses that are not work-related may predesignate their personal physician to treat an occupational injury or illness—they are no longer limited to physicians within the employer’s medical provider network (MPN). Previously, only workers whose employer offered a group health plan could choose to have their personal physician treat an occupational injury or illness.
The procedure for predesignation varies depending on the employer’s arrangements, as follows:
If the Employer Contracts with a Healthcare Organization
In the case of an HCO (an organization certified by the DWC to provide managed medical care to injured workers) the employer or insurer must give a copy of DWC Form 1194 to each employee within 30 days after the date of hire and at least once a year.
The worker can use this form to predesignate his or her personal physician, personal chiropractor, or personal acupuncturist. The worker is not required to show that the healthcare professional agreed to be predesignated.
Workers must predesignate each time they receive Form 1194. If they don’t, the employer can enroll them in the HCO, and any job-related injuries or illnesses they incur will be treated in the HCO.
If the Employer Does Not Contract with an Hco and the Worker Has Healthcare Insurance for Non-work-related Injuries and Illnesses
In this case, the worker can predesignate a medical doctor (MD), doctor of osteopathy (DO), or a medical group that includes MDs or DOs that has treated the worker in the past and has his or her medical records.
Unlike workers whose employers contract with an HCO, these workers cannot predesignate their personal chiropractor or acupuncturist. If, however, they give their employer the name of their personal chiropractor or acupuncturist in writing before they are injured, they may switch to their chiropractor or acupuncturist on request after they first see a doctor chosen by a claims administrator.
The individual physician or medical group must agree in advance, in writing, to treat the worker for any job-related injuries and illnesses. The written consent must be included with the worker’s predesignation.
Nikki Mehrpoo Jacobson Attorney at Law / Professor of Law firstname.lastname@example.org THE JACOBSON LAW FIRM, APC Immigration & Nationality ǀ Workers' Compensation 510 West 6th St. Suite 326 Los Angeles , CA 90014 (310) 277-2266 (310) 277-3366 FAX Los Angeles Immigration Lawyers - Free Consultation www.thelosangeleslawyers.com