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Your employer has the legal obligation to provide you with medical treatment for your workers’ compensation injury. Within 24 hours of reporting your injury, you should be sent for an initial visit with a physician within the employer’s Managed Provider Network (“MPN”). You do not have to keep going to this doctor for continued medical care.
After your first doctor visit, you should receive written documentation from the employer about the MPN and procedures for selecting a physician from the MPN list. This is usually provided as a link to a web page. If your claim for your work injury is accepted, you may have a right to request a transfer to a different physician. You can even ask for a physician that is not in the employer’s MPN but who will accept workers’ compensation patients. However, this is subject to specific regulatory requirements. If you are having difficulty obtaining information about your employer’s MPN, or are having difficulty selecting a different treating physician, we can help.
Medical treatment that is provided to you by workers’ compensation insurance, in an accepted claim, includes doctor visits (this can include visits to a chiropractor, acupuncturist, psychologist, and podiatrist, among others), hospitalization, medications, and supportive devices such as canes. However, this medical treatment must be provided by a workers’ compensation physician who follows procedures established by the Department of Industrial Relations (DIR).
The DIR has set up medical standards that your workers’ compensation treating physician must follow called Medical Treatment Utilization Standards (MTUS). Your doctor must submit Requests for Authorization (RFAs) to the insurance company, along with reports that explain why the medical treatment requested complies with the MTUS. The insurance company will typically submit the RFA through a process called Utilization Review (“UR”). A UR doctor will review the RFA and report and will approve, deny, or modify your treating doctor’s request, based on whether the UR doctor believes it complies with the MTUS standards. Your doctor can appeal the UR decision. Or, the decision can be appealed through a process called Independent Medical Review (IMR).
Once a decision has been made through UR and IMR, it cannot be changed for a year. We understand that the UR/IMR process appears unfair and can often delay your treatment, resulting in longer time off from work. There are some avenues an experienced workers’ compensation attorney can take to help you get treatment and benefits despite UR/IMR denials of treatment.
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