Medical Treatment

The most common question injured workers ask is also the one most often answered wrong online: can I see my own doctor?

The honest answer is that it depends almost entirely on whether your employer has a Medical Provider Network — and today, nearly all of them do.

The one thing to do before you are ever injured.

If you file a written predesignation with your employer before you get hurt, you have the right to treat with your own doctor from the date of injury — no network, no thirty-day control period.

It takes one form. Almost nobody does it, and of the people who try, many get it wrong. The requirements are below.

What you are owed

Labor Code § 4600 obligates the employer to provide "medical, surgical, chiropractic, acupuncture, licensed clinical social worker, and hospital treatment, including nursing, medicines, medical and surgical supplies, crutches, and apparatuses, including orthotic and prosthetic devices and services" — whatever is reasonably required to cure or relieve you from the effects of the injury.

Two words in that sentence carry disproportionate weight.

"Cure or relieve." Palliative care qualifies. Treatment does not have to fix anything, and you do not have to prove your condition is curable. A claim that treatment is "only palliative" is not, by itself, a valid denial.

"Neglects or refuses." Section 4600(a) goes on to provide that where the employer neglects or refuses to seasonably provide treatment, the employer is liable for the reasonable expense of treatment you obtain yourself. That is the statutory basis for reimbursement of self-procured care, and it is what Braewood Convalescent Hospital v. WCAB (1983) enforces.

And remember that up to $10,000 in treatment must be authorized within one working day of your filing a claim form, and continues until liability is accepted or rejected — regardless of whether the claim has been decided (LC § 5402(c)).

The Medical Provider Network

An MPN is a list of physicians the employer or insurer has assembled. If your employer has one, your treatment generally has to come from inside it.

The access standards are real, and they are enforceable. An MPN must provide a primary treating physician within 30 minutes or 15 miles of your residence or workplace, and an occupational health specialist and hospital within that same standard. For specialists, the standard is 60 minutes or 30 miles.

The notice requirements are also real. The employer must give you written notice of the MPN — what it is, how to find a physician, how to change physicians, and how to dispute a treatment decision — at specific points, including at the time of injury.

Changing doctors inside the network

You are not stuck with the first doctor. Within an MPN you may:

1. Change to any other physician in the network, at any time, without permission.
2. Get a second opinion from a network physician if you disagree with your treating physician's diagnosis or treatment plan.
3. Get a third opinion if you still disagree.
4. Request MPN Independent Medical Review if the third opinion does not resolve it.

Most workers never learn steps 2 through 4 exist. You do not need anyone's approval to switch to a different doctor within the network — and if the relationship with your treating physician has broken down, that is often the fastest fix available.

Getting out of the network

There are real routes out, and they matter:

Predesignation. See below. This is the cleanest route and it must be set up in advance.

The claim is denied. If the employer rejects liability, it is not directing your care.

Defective MPN notice that caused a denial of care. Under Knight v. United Parcel Service (WCAB en banc, 2006), an employer's failure to give proper MPN notice can cost it control of treatment where that failure resulted in a neglect or refusal to provide care. The 2012 reforms narrowed this — a technical notice defect alone is no longer automatically enough — but where bad notice actually caused you to go without treatment, it remains live.

Access failure. If the network cannot actually deliver a physician meeting the access standards, in the right specialty, within a reasonable time, it is not functioning as a network.

A favorable MPN Independent Medical Review determination.

Continuity of care. In defined circumstances, ongoing treatment with a physician outside the network can be continued rather than transferred.

And one thing that is not a route out: simply preferring a different doctor. That is not a basis, and being told otherwise sets people up for unpaid bills.

Predesignation — the form to file before anything happens

Labor Code § 4600(d) gives you the right to treat with your own physician from the date of injury if you notified your employer in writing before the injury and you have non-occupational health coverage.

Five requirements, all of which must be satisfied before you are hurt:

A correction to guidance you will find elsewhere. Many pages state that your employer must offer group health insurance for predesignation to work. That was the old rule. The current statute requires only that you have non-occupational health coverage on the date of injury — from any qualifying source, including a spouse's plan or a policy you bought yourself.

Predesignation beats the MPN, because the right operates "from the date of injury" — there is no employer control window at all. The employer does retain utilization review rights over what your doctor requests.

There is no cure for missing this. File it before the injury or the right is gone. If you have a doctor you trust and a job with any physical risk, this is worth twenty minutes this week.

(A separate and weaker right exists for predesignating a personal chiropractor or acupuncturist under LC § 4601, but it works only where the employer has no MPN.)

If your employer has no MPN

Then the older rules apply, and they are more generous:

• One free change of physician on request. The claims administrator must provide an alternative physician no later than 5 working days from receiving your request (LC § 4601(a)).
• After 30 days from the date the injury is reported, you may treat with a physician of your own choice within a reasonable geographic area (LC § 4600(c)). On notice, the claims administrator has 20 days to authorize.

Note the trigger: 30 days from when the injury is reported, not from the date of injury.

Any website telling you "you can choose your own doctor after 30 days" without mentioning the MPN exception is misleading nearly everyone who reads it, because almost the entire insured market operates an MPN.

Your primary treating physician

You have one primary treating physician at a time. That doctor is responsible for your overall care, for writing the reports that drive your case, and for requesting authorization for treatment.

The reports matter enormously. The Doctor's First Report, the periodic PR-2 reports, and the permanent and stationary report are the documentary spine of your claim — they determine your work status, your restrictions, and ultimately your impairment.

A treating physician who does not write, or writes thinly, damages your case even if the medical care is fine. That is a legitimate reason to change doctors.

The 24-visit caps

Under Labor Code § 4604.5(c), for injuries on or after January 1, 2004, you are generally limited to 24 chiropractic visits, 24 physical therapy visits, and 24 occupational therapy visits per industrial injury.

The employer may authorize more in writing, and post-surgical physical medicine is treated separately under the applicable guidelines. Note also that after 24 chiropractic visits, a chiropractor generally cannot continue as your primary treating physician without written authorization.

Things you are owed that nobody mentions

Mileage. Reimbursed at the current rate — 76¢ per mile for travel on or after July 1, 2026 (it was 72.5¢ for the first half of the year). Keep a log: dates, destinations, and round-trip miles. It adds up faster than people expect over a long claim.

Interpreters. For medical treatment appointments and medical-legal evaluations. You pay nothing.

Transportation, parking, and in some circumstances lodging and meals for treatment travel.

Home health care, where medically necessary and prescribed, subject to the requirements of LC § 4600(h).

Your own doctor at your own expense. Under LC § 4605 you may always consult a physician of your choosing at your own cost, and that physician's report can be used as evidence in your case — though it cannot be the sole basis for an award.

Frequently asked questions

What people actually ask about treatment

• Do I have to go to the company clinic?for the first visit, often yes. After that, much less than you have been told
• Can I get mental health treatment?a separate route with its own threshold, and one that is routinely not offered
• There's a nurse at my appointments.she works for the insurance company, and no statute puts her in the exam room
• What if I need surgery?the authorization path, and where it stalls
• I'm a veteran with VA benefits.two systems that do not coordinate themselves