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It has been my understanding that the pre-designation of a personal physician for work injuries required that the physician be a part of our group health plan. However, I've been challenged with an employee who is saying that as long as the physician is the regular treating physician, it doesn't matter that he isn't a part of the group health plan. I've looked at the info from the State of CA, but it doesn't specifically say that the physician must be a part of the company's group health plan - it just says that the company has to have one.
Anybody out there able to help me out?
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This is taken from the "Facts About Workers' Compensation" pamphlet Physician Predesignation form:
You can be treated immediately by your personal medical doctor (M.D.) or a doctor of osteopathy (D.O.) if:
- your employer offers group health coverage;
- the doctor has treated you in the past and has your medical records;
- prior to the injury the doctor has agreed to treat you for work injuries or illnesses...
The physician must also give his written consent on this form.
Those employees who are not covered by the employer's group plan (may be covered by spouse's plan) would still be allowed to pre-designate a physician.
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| What if the employee has already been seen by the industrial clinic/physician provided by the company and they are not in agreement with the treatment given, do they have a right to a 2nd opinion by a Doctor of their own choice?
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| Does your W/C carrier use a MPN? If so, the EE can get a 2nd opinion, but only from a provider within the MPN. I don't have the resources in front of me at the moment, but I believe the predesignation must be approved by the carrier. Call your carrier/adjuster for advice.
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