Medical Provider Networks – A Workers’ Compensation Lawyer in Orange County Perspective

 A dose of reality: Imagine you’ve been injured at work, and your employer insists that you be treated with a doctor within the insurance company’s Medical Provider Network (MPN). You might assume that this doctor will address ALL of your injuries, but injured workers are all too often told they can’t provide comprehensive treatment because “the adjuster will only let me treat some of your injuries”. Thus “minor” injuries are left untreated, or the insurance company refuses to authorize a referral to a specialist. Unfortunately, there are instances when even well-intentioned doctors face obstacles from insurance companies that hinder them from providing the necessary treatment.

How could this happen? Because MPN’s are also focused on “cost containment” – also known as saving money at the expense of your health.

If you find yourself in this situation, you need to know you have powerful rights.

1. Document Treatment Failures in Writing

Your primary goal is to heal and return to work. To achieve this, it’s crucial not to keep these concerns to yourself. Documenting treatment failures in writing will bring these issues into the open, document the failures and create a record for a Judge if the failures in court. Insurance companies may easily disregard phone calls, so consider sending a fax or email to provide evidence of your efforts to resolve the issues.

2. Request a Second Opinion

Sometimes, a different doctor might have an alternative approach to your treatment. You have the right to request another physician to provide care. After insisting that you have access to the ENTIRE LIST of physicians in the MPN, you can make a request in writing for another physician to treat you. Unfortunately, another MPN doctor will be faced with the same “cost containment” pressures from the claim adjuster.

3. Seek Legal Assistance

If your verbal and written efforts still yield no satisfactory results, it may become necessary to seek legal help. Consult with an experienced workers’ compensation attorney in Orange County who understands the intricacies of workers’ compensation law. They can guide you through the process and ensure that your rights are protected. An attorney can also pursue ALL of the treatment you require.

Contact Thomas F. Martin, PLC for Assistance

Thomas F. Martin, an attorney with over 30 years of experience in California Workers’ Compensation law, has a strong track record of resolving treatment issues for his clients. Reaching out to him can provide you with valuable insights on how to navigate the challenges and pursue your valuable rights. If you’re concerned about your medical treatment rights, don’t hesitate to contact Thomas F. Martin, PLC. Mr. Martin is here to assist you. You can reach him at 714-547-5025 for more information about your workers’ compensation concerns.