Find a REAL workers comp doctor...and HURRY!
by
Nancy Wallace on Jan. 31, 2017
Employment Workers' Compensation
Summary: MPN -- Medical Provider Network -- doctors are tough to find, try these tips to get a real doctor to help your heal from your workers comp injury
FIND A REAL WORKERS COMP DOCTOR... and HURRY!
All of your medication, your braces and your therapy come from a Treating Doctor who requests them exactly the right way from an insurance adjuster. If the doctor the boss told you to see doesn't request your care the right way, you just don't get any care...it isn't fair, but it's the law (and the current governor and Assembly show zero evidence of caring about suffering of injured workers).
So your best strategy for a quick recovery is to find a doctor who isn't afraid to request the treatment and meds you need, and knows how to do it.
Trouble is, you are stuck with only the doctors on the comp insurer's Medical Provider Network. You cannot use your personal doctor. The Calif. Labor Code says the WCAB Judge doesn't have to look at orders from a physician not listed in the Medical Provider Network, that MPN ... so you must go find a good doctor in the MPN.
HOW DO YOU FIND the MPN? It's difficult. The Labor Code requires the Insurance Company send you a written letter with the website to read the MPN Doctors online, plus a phone number of a 'liaison' (counselor) to help you find an MPN Doctor if you do not have internet access.
CAUTION: if you use the insurance company's counselor to pick an MPN doctor, the counselor doesn't have to give you every doctor on the list in your area...she can give you one or two names of very conservative doctors who only prescribe aspiring and light duty and don't give you any therapy or prescription medications to save the insurance company money. It is in your best interest to find someone with internet access and find all the physicians available to you so you can research as many options as possible.
Online, the search tool typically limits you to about 10 miles from your zip code. I put in several surrounding zip codes and search for doctors. It is worth driving 60 miles for a real doctor if that is the nearest real doctor on your MPN.
You can search for several specialties. Chiropractors typically can see you in a day or two, so if you need someone right away, start with a chiropractor. Trouble is, Chiropractors cannot prescribe pain medication; so if you need prescription pain killer, you will need to switch to an M.D. (licensed Medical Doctor) or D.O. (Licensed Osteopath) in a few days.
Another specialty you can consider is Pain Management, also called Anesthesiology. Orthopedics and Orthopedic Surgery searches are most common for spine sprains/strains, but Physiatry and PHysical Medicine are frequently better options for back pain injuries.
Orthopedists can treat foot injuries, but so can Podiatric Medicine doctors (DPMs).
I pick doctors that advertise for patients in a variety of ways: a doctor who can be reviewed on Yelp and Manta is more likely to listen to you and care about your outcome than a doctor who has no online presence. A doctor in a group such as Kaiser does not write a report; remember, no written report requesting treatment, no treatment. (Kaiser only uses a handful of doctors to write for all doctors in the group, so a physician who has never treated you but seen you one time for a few minutes writes all about you, frequently with disastrous consequences, a scenario to avoid when possible.)
Call the doctor on the MPN you are considering before choosing that doctor, and ask how the doctor gets Workers Comp insurers to authorize pills. Ask if anybody there sends out the RFA. Ask if anybody there knows what an RFA is.
An RFA is a Request for Authorization. When a doctor prepares this properly and faxes it to the adjuster, the insurance company has only 5 business days to either OK the treatment or deny the treatment...and if the denial is late, you get to go to a judge to request the treatment be ordered.
If the doctor never does an RFA, you might never get any treatment. If the doctor is not up-to-speed and just has a staffer phone and beg for treatment, You might not get anything (except visits to that doctor every 4 weeks with a shrug from the doctor with "we're still waiting to hear back from the adjuster".)
Ask the doctor's staff if they know how to help you get authorizations for treatment. If the person on the phone knows nothing, they don't want workers comp patients there, keep looking.
Ask the doctor's staff if they help you get the OKAY from the adjuster for the first exam...if they don't make contact with the adjuster for the first exam and just sit around hoping an adjuster might respond, think about the next MPN doc on the list.
CHECK TO SEE IF THE DOCTOR listed is really at the location listed. The MPN lists are filled with deceased doctors, doctors who have left that medical group location, doctors who were retired or suspended, and doctors no longer accepting any workers compensation claims.
WHEN YOU FIND a real doctor who advertises online and in the yellow pages, you put your demand to authorize that doctor IN WRITING to the adjuster... i strongly suggest faxing it. It can be hand-written, it doesn't have to be fancy: "Dear ADjuster, from your MPN I selected Dr. Primary Treater as my new MPN Treating PHysician, and demand that you immediately authorize Dr. Treater to see me immediately; his phone is 866,888.8888 and his fax is 866,886.6666. Thanks you in advance for your quick response. If Dr. Treater isn't okayed to see me by the 15th of this month, I'll ask the Information & Assistance Officer to set my claim for a WCAB Hearing. Sincerely, Me" is perfect.
FAX THIS then save a copy of the Fax Transmission Report...you might have to show this to a WCAB Judge in 6 weeks.
AND if you are Okayed to see your new doctor by the deadline, it's time for an attorney.
AND if you are Okayed to see your new doctor and you have a bad result, start the process over again until you get a real doctor who really fights for you.
Or hire an attorney with personal knowledge of the doctors in your area who fight for injured workers...it's well worth the 12-15% of your final recovery to get to a doctor who really helps you instead of helping the insurance company.
All of your medication, your braces and your therapy come from a Treating Doctor who requests them exactly the right way from an insurance adjuster. If the doctor the boss told you to see doesn't request your care the right way, you just don't get any care...it isn't fair, but it's the law (and the current governor and Assembly show zero evidence of caring about suffering of injured workers).
So your best strategy for a quick recovery is to find a doctor who isn't afraid to request the treatment and meds you need, and knows how to do it.
Trouble is, you are stuck with only the doctors on the comp insurer's Medical Provider Network. You cannot use your personal doctor. The Calif. Labor Code says the WCAB Judge doesn't have to look at orders from a physician not listed in the Medical Provider Network, that MPN ... so you must go find a good doctor in the MPN.
HOW DO YOU FIND the MPN? It's difficult. The Labor Code requires the Insurance Company send you a written letter with the website to read the MPN Doctors online, plus a phone number of a 'liaison' (counselor) to help you find an MPN Doctor if you do not have internet access.
CAUTION: if you use the insurance company's counselor to pick an MPN doctor, the counselor doesn't have to give you every doctor on the list in your area...she can give you one or two names of very conservative doctors who only prescribe aspiring and light duty and don't give you any therapy or prescription medications to save the insurance company money. It is in your best interest to find someone with internet access and find all the physicians available to you so you can research as many options as possible.
Online, the search tool typically limits you to about 10 miles from your zip code. I put in several surrounding zip codes and search for doctors. It is worth driving 60 miles for a real doctor if that is the nearest real doctor on your MPN.
You can search for several specialties. Chiropractors typically can see you in a day or two, so if you need someone right away, start with a chiropractor. Trouble is, Chiropractors cannot prescribe pain medication; so if you need prescription pain killer, you will need to switch to an M.D. (licensed Medical Doctor) or D.O. (Licensed Osteopath) in a few days.
Another specialty you can consider is Pain Management, also called Anesthesiology. Orthopedics and Orthopedic Surgery searches are most common for spine sprains/strains, but Physiatry and PHysical Medicine are frequently better options for back pain injuries.
Orthopedists can treat foot injuries, but so can Podiatric Medicine doctors (DPMs).
I pick doctors that advertise for patients in a variety of ways: a doctor who can be reviewed on Yelp and Manta is more likely to listen to you and care about your outcome than a doctor who has no online presence. A doctor in a group such as Kaiser does not write a report; remember, no written report requesting treatment, no treatment. (Kaiser only uses a handful of doctors to write for all doctors in the group, so a physician who has never treated you but seen you one time for a few minutes writes all about you, frequently with disastrous consequences, a scenario to avoid when possible.)
Call the doctor on the MPN you are considering before choosing that doctor, and ask how the doctor gets Workers Comp insurers to authorize pills. Ask if anybody there sends out the RFA. Ask if anybody there knows what an RFA is.
An RFA is a Request for Authorization. When a doctor prepares this properly and faxes it to the adjuster, the insurance company has only 5 business days to either OK the treatment or deny the treatment...and if the denial is late, you get to go to a judge to request the treatment be ordered.
If the doctor never does an RFA, you might never get any treatment. If the doctor is not up-to-speed and just has a staffer phone and beg for treatment, You might not get anything (except visits to that doctor every 4 weeks with a shrug from the doctor with "we're still waiting to hear back from the adjuster".)
Ask the doctor's staff if they know how to help you get authorizations for treatment. If the person on the phone knows nothing, they don't want workers comp patients there, keep looking.
Ask the doctor's staff if they help you get the OKAY from the adjuster for the first exam...if they don't make contact with the adjuster for the first exam and just sit around hoping an adjuster might respond, think about the next MPN doc on the list.
CHECK TO SEE IF THE DOCTOR listed is really at the location listed. The MPN lists are filled with deceased doctors, doctors who have left that medical group location, doctors who were retired or suspended, and doctors no longer accepting any workers compensation claims.
WHEN YOU FIND a real doctor who advertises online and in the yellow pages, you put your demand to authorize that doctor IN WRITING to the adjuster... i strongly suggest faxing it. It can be hand-written, it doesn't have to be fancy: "Dear ADjuster, from your MPN I selected Dr. Primary Treater as my new MPN Treating PHysician, and demand that you immediately authorize Dr. Treater to see me immediately; his phone is 866,888.8888 and his fax is 866,886.6666. Thanks you in advance for your quick response. If Dr. Treater isn't okayed to see me by the 15th of this month, I'll ask the Information & Assistance Officer to set my claim for a WCAB Hearing. Sincerely, Me" is perfect.
FAX THIS then save a copy of the Fax Transmission Report...you might have to show this to a WCAB Judge in 6 weeks.
AND if you are Okayed to see your new doctor by the deadline, it's time for an attorney.
AND if you are Okayed to see your new doctor and you have a bad result, start the process over again until you get a real doctor who really fights for you.
Or hire an attorney with personal knowledge of the doctors in your area who fight for injured workers...it's well worth the 12-15% of your final recovery to get to a doctor who really helps you instead of helping the insurance company.