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Work comp adjuster changing doctors CA
#1
After two years of fighting to see an orthopedic surgeon, because they couldn't find one, I finally get into one. I go and get a CRPS diagnosis and am promptly told a few days later, right after the doctor wrote the report saying that I am no longer going to see him "because he is too far" and that they have found a doctor closer to home. #1 How is it that it took you 2 years to find a doctor, but could never find anyone except RIGHT after diagnosis" #2 Doesn't that sound weird?
Even if it weren't a location issue, such as where the doctor is, is the adjuster allowed to change treating doctors?

Also, I was supposed to see a different type of surgeon as well, separate from my orthopedic surgeon. It has been authorized from UR 6 months ago. They have someone they could send me to but they say "Its too far" and they clearly can't find anyone closer. Is it legal for them to just sit on it? I thought there were rules and regulations that a patient had to see a doctor within a certain amount of time frame after the referral was written and the UR approved it. At this point we are looking at waiting another year to see this doctor. I mean, literally, is it legal for them to wait years? That's what its going to come to. I thought it was classified as delayed medical care.
 
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#2
Every state’s comp rules are different. What is yours?
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#3
I see it now it’s in the title.
Does the employer carrier use a network? Doctors come and go regularly.
No they can’t change your doctor but they don,t have to pay if its outside the rules.
You can change to another doctor in the network.
Labor code 4600: “ © Unless the employer or the employer’s insurer has established or contracted with a medical provider network as provided for in Section 4616, after 30 days from the date the injury is reported, the employee may be treated by a physician of his or her own choice or at a facility of his or her own choice within a reasonable geographic area.”
A dispute over the meaning can be taken to the comp court.
Rules for medical provider networks are here
https://www.dir.ca.gov/t8/ch4_5sb1a3_5.html

Sounds like you need to get the comp court involved to sort the treatment out.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#4
(05-09-2019, 12:55 AM)1171 Wrote: I see it now it’s in the title.
Does the employer carrier use a network? Doctors come and go regularly.
No they can’t change your doctor but they don,t have to pay if its outside the rules.
You can change to another doctor in the network.
Labor code 4600: “ © Unless the employer or the employer’s insurer has established or contracted with a medical provider network as provided for in Section 4616, after 30 days from the date the injury is reported, the employee may be treated by a physician of his or her own choice or at a facility of his or her own choice within a reasonable geographic area.”
A dispute over the meaning can be taken to the comp court.
Rules for medical provider networks are here
https://www.dir.ca.gov/t8/ch4_5sb1a3_5.html

Sounds like you need to get the comp court involved to sort the treatment out.
My attorney says that they are able to change your doctor freely whenever they want. I said that is ridiculous so he said he will "write a letter to try and keep your doctor" but he said if he does that I forgo any and all mileage and or transportation from them going further because "why would they pay mileage for that doctor when this one is closer" and I responded well "they sent me to that doctor because they couldn't find anyone closer"
I can't get the comp court involved, he won't go to court for anything.
Yes the carrier uses an MPN and the doctor is within the MPN.
I really want to keep my doctor as he is actually helping me with my medical care, however, he is giving unfavorable diagnosis's to the carrier.
Thanks for the links I'll take a look at them
 
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#5
Doesn’t appear that you or your atty are familiar with the MPN rules I linked to.
You can switch to another doc within the network at any time:
9767.6
“ (e) At any point in time after the initial medical evaluation with an MPN physician, the covered employee may select a physician of his or her choice from within the MPN. Selection by the covered employee of a treating physician and any subsequent physicians shall be based on the physician's specialty or recognized expertise in treating the particular injury or condition in question.“
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#6
(05-09-2019, 01:35 PM)1171 Wrote: Doesn’t appear that you or your atty are familiar with the MPN rules I linked to.
You can switch to another doc within the network at any time:
9767.6
“ (e) At any point in time after the initial medical evaluation with an MPN physician, the covered employee may select a physician of his or her choice from within the MPN. Selection by the covered employee of a treating physician and any subsequent physicians shall be based on the physician's specialty or recognized expertise in treating the particular injury or condition in question.“
Yeah, I looked through the links. I see nothing about them being able to freely changing the claimants doctors whenever they please. The 9767.6 you linked says that I can select a physician, but nothing about them doing so.
I have always understood I can switch to another doctor, just wasn't sure if they could switch it for you, for their own purposes as they no longer like this doctor, and I do. I do not want to change my doctor, they said tough
I actually told my attorney I would like him to enforce the regulations and codes and he said he is not willing to do so. Doesn't care about the links says I am not right.
Seems like work comp is lawless, at least with my case it is.
 
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#7
??? You’re making it too difficult.
Since you have the legal authority, you just keep switching.

But of course it’s all for naught and just a game since without court intervention they can do what they want, when they want.
Why do you keep coming back to add more to the list of errors that’ll never get corrected?
Why do you care what the rules say since nothing will happen to change things?
I don,t understand....
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#8
How many miles is the doctor you want to see from your home? I am curious.

You have every right to pick the doctor in your MPN as 1171 wrote. Once you receive a UR approval for a specialist (it sounds like that is what happened)you should then loo through the MPN and pick a doctor and then alert your attorney to notify the adjuster who you picked and to please provide written authorization to the doctor. Not all doctors want this after a UR approval, but many will not see an injured worker without it and a UR approval is not enough. I recomend sending your attorney a copy of a print out of the MPN page where the doctor is listed. This is how it is supposed to work.

However injured workers who receive a UR approval to see a specialist and then do not pick one from the MPN will either allow the adjuster to pick the doctor (bad idea) or nothing happens and the IW goes without seeing any doctor. This is why the IW needs to take the initiative.

If your attorney is not willing to help you then you can chose to allow this to happen, try to hire another attorney or represent yourself.

With that being said if this doctor is a long distance away I can see why the carrier would not think it is reasonable to pay for mileage if there are others much closer. I have seen physicians in the MPN who were 40 miles away. I did not have any issues with my adjuster. If it were 100 mies away I could see where they may have a problem and why I asked. I would have to see if there are rules on this, where they can refuse to pay mileage for an MPN doctor claiming distance issues. Also, CRPS can be difficult to diagnose and treat, and I wonder if for that reason it warrants treating outside of your area. (unknown) Your attorney should be helping you with this stuff. That condition is serious.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#9
(05-09-2019, 11:51 PM)California_Help Wrote: How many miles is the doctor you want to see from your home? I am curious.

You have every right to pick the doctor in your MPN as 1171 wrote. Once you receive a UR approval for a specialist (it sounds like that is what happened)you should then loo through the MPN and pick a doctor and then alert your attorney to notify the adjuster who you picked and to please provide written authorization to the doctor. Not all doctors want this after a UR approval, but many will not see an injured worker without it and a UR approval is not enough. I recomend sending your attorney a copy of a print out of the MPN page where the doctor is listed. This is how it is supposed to work.

However injured workers who receive a UR approval to see a specialist and then do not pick one from the MPN will either allow the adjuster to pick the doctor (bad idea) or nothing happens and the IW goes without seeing any doctor. This is why the IW needs to take the initiative.

If your attorney is not willing to help you then you can chose to allow this to happen, try to hire another attorney or represent yourself.

With that being said if this doctor is a long distance away I can see why the carrier would not think it is reasonable to pay for mileage if there are others much closer. I have seen physicians in the MPN who were 40 miles away. I did not have any issues with my adjuster. If it were 100 mies away I could see where they may have a problem and why I asked. I would have to see if there are rules on this, where they can refuse to pay mileage for an MPN doctor claiming distance issues. Also, CRPS can be difficult to diagnose and treat, and I wonder if for that reason it warrants treating outside of your area. (unknown) Your attorney should be helping you with this stuff. That condition is serious.
The doctor I have been seeing with is located in another state, about 2.5 hours away one way,but they are the ones who sent me to them in the first place, I didn't choose to see him as I never picked him specifically and was sent to him. However, of course now that I am treating with him I want to stay with him. They don't pay for mileage per say but they do transport me.
I just am stressed because THEY sent me to this doctor, I didn't pick this doctor and now they are citing distance issues after THEY couldn't find someone locally. That is all.
TLDR; Seeing treating doctor and Workers comp calls up and says we don't want you seeing this doctor anymore we found you a new one, even though they are the ones who sent me to this doctor in the first place. Basically, they can cite issues with distance after they already have been sending you there?
 
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#10
(05-09-2019, 04:52 PM)1171 Wrote: ??? You’re making it too difficult.
Since you have the legal authority, you just keep  switching.

But of course it’s all for naught and just a game since without court intervention they can do what they want, when they want.
Why do you keep coming back to add more to the list of errors that’ll never get corrected?
Why do you care what the rules say since nothing will happen to change things?
I don,t understand....
No idea what your comment "Since you have the legal authority, you just keep  switching." means. I keep switching what?
 
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