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WC California - Flipping fran - 02-22-2020

Hi all, so here's my question, since the QME has deemed me P&S and I'm pretty sure that my PTP will agree ,what is the procedure for medical treatment? Do I have to continue with the IC network doctors or can I see my doctor of my choice? I've tried to search for the this information to no avail. Medicare kicks in March 1st and I do have an MSA, but the IC has done nothing more than send PD payments which I'm grateful for ,however social security has me on disability already. It's so confusing.

Thanks in advance


RE: WC California - 1171 - 02-23-2020

They’ll only pay for docs within the network. After a C&R is approved by the court you can choose any doc.


RE: WC California - 1171 - 02-23-2020

More information about a comp settlement with medicare
https://www.workcompwire.com/2019/06/christie-britt-horns-of-a-dilemma-part-2-settlement-strategies-where-medicare-is-involved/


RE: WC California - Flipping fran - 02-23-2020

1171 thanks for your response, but if I'm P&S and there isn't any treatment in the works what do I do in the meantime for any treatment? Is it just a waiting game from the IC for settlement at this point? The only reason to continue to see my PTP is for medication. The link you provided was very helpful too.

Thanks Again


RE: WC California - 1171 - 02-23-2020

you can see any doctor at your own expense at any time.
while you have an open claim, comp controls your medical benefits for the work injury.


RE: WC California - Flipping fran - 02-23-2020

1171 thanks for the information


RE: WC California - Buddy1114 - 04-06-2020

I was deemed permanent and stationary about 6 months into my case and currently I'm 93 months into my WC case. My case could be slightly different since I had pending depression/anxiety issues (PQME) but even after P&S with mental my case still isn't closed. In my personal opinion it seems like as long as your PTP and the doctors he refers you to are treating you then your case is open. When to close a case is based off of the legal parties involved. Not the doctors. To the best of my knowledge.

Also (in CA at least) you are allowed to change your PTP (in CA you can have up to three, more under special circumstances). My first doctor was a nightmare, my second doctor wanted to jump straight to surgery and my third doctor was juuuuust right. He's amazing. So to answer your question you do have SOME control over your PTP. The only other thing that comes into play is the MPN. For example my insurance had one WC doc in the MPN and he was HORRENDOUS so the only other options were outside the MPN which gave me complete freedom with choosing my medical providers.


RE: WC California - 1171 - 04-06-2020

You can change docs within the MPN as often as necessary.
Cases are not closed when there are on -going benefits to be paid.