“Can I see my own doctor?”

Predesignation — the form that only works in advance

The law permits you to name your own personal physician, and all of these must be true before the injury:

• You have health insurance covering non-occupational injuries
• The physician is your primary care physician and has treated you before
• The physician has treated you before, keeps your medical records, and agrees in advance to be predesignated
• Your employer is notified in writing before the injury occurs

Chiropractors, acupuncturists, and psychologists cannot be predesignated under this provision.

And every employer is required to give you the predesignation form and notice at hire or by the end of your first pay period. Most workers never see it.

If you are reading this and you are not currently injured: predesignate today. It is ten minutes of paperwork and it is worthless afterward.

If you did not predesignate

The employer controls your care for the first 30 days. After that you may change — but within the MPN if there is one.

And here is the right nobody uses: after the first visit, you may switch to any other physician in the network without asking permission. No form, no fight, no deadline. If you do not like your treating doctor, change.

The employer must give you access to a current MPN provider list. How the MPN works.

The four exceptions

Emergency care — always.

Defective or missing MPN notice. MPN notice obligations are specific, and a defective or missing notice can be a basis for treating outside the network where it led to a denial of care.

Failure of access. No appropriate specialist, no available appointment within the required timeframes, no usable provider list. A network that cannot actually provide care has a problem.

And after a successful MPN independent medical reviewIMR Independent Medical Review. The appeal from a UR denial. 30 days (10 if the dispute is only over drugs on the MTUS Drug List).. Where the reviewer agrees with you, “the injured employee may seek the disputed treatment or diagnostic service from a physician of his or her choice from within or outside the medical provider network,” and the employer is liable for the cost.

One distinction worth keeping straight

Treating physician — the doctor who treats you. Governed by the MPN.

Medical-legal evaluator (QMEQME Qualified Medical Evaluator. A state-certified physician who resolves disputes. Unrepresented workers get a panel of three by random draw. or AMEAME Agreed Medical Evaluator. A physician both sides agree on. Available only to represented workers, and practically very hard to move away from.) — not treatment. An examination to resolve a dispute, which produces the report your rating is built from. You do not choose this one the same way, and the selection rules have short deadlines. The QME process. · What is an AME?