How Pre-Designation Of Doctors Became Lawful Requirement

The predesignation of a medical doctor became law in 1976, with the passing of the Legislative amendments to Labor Code (LC) Section 4600. This law narrowed an employer's control to designate a treating physician to the first 30 days following the report of the worker's industrial injury. After this 30-day period, the injured worker was able to select their own physician, unless the employer could show good cause to the Workers' Compensation Appeals Board.

Pre-designation of a physician

To be able to pre-designate a physician, certain conditions must be met. Firstly, your employer must offer group health coverage. Secondly, the doctor must be your regular physician, and they should be either a physician who has limited their practice of medicine to general practice or be a board-certified or board-eligible internist, pediatrician, obstetrician-gynecologist, or family practitioner. Additionally, they should have previously directed your medical treatment and retain your medical records.

Prior to any injury, your doctor must agree to treat you for work-related injuries or illnesses, and you must provide your employer with written notice of your preference to be treated by your personal doctor for work-related issues. This notice should include your personal doctor's name and business address.

It is important to note that the process of pre-designation may vary depending on whether your employer has a Medical Provider Network (MPN) in place. If your employer has an MPN, you will need to treat within that network unless you have properly pre-designated a personal physician before the injury. On the other hand, if your employer does not have an MPN, they can exercise medical control for the first 30 days following the date of injury, after which you can request a change of treating physician.

By pre-designating a physician, you can ensure that you receive treatment from a doctor who is familiar with your medical history and can provide more individualized care. However, it is essential to confirm that your pre-designated physician is willing to abide by the laws and regulations when requesting treatment to avoid potential delays or denials.

Pre-designation when the employer has a Medical Provider Network (MPN)

A Medical Provider Network (MPN) is a network of medical service providers created to provide medical treatment for work injuries of employees in California. Self-insured employers, workers' compensation insurers, or entities providing physician network services may establish an MPN. An MPN must be approved by the California Division of Workers' Compensation (DWC) before it can be used.

Under LC 4600(d), an employee who properly pre-designates a personal physician can treat with that physician despite an employer's properly established MPN. When there is a properly established MPN, every new employee must be provided notice of the requirements to pre-designate as well as a pre-designation form when hired or prior to the end of the first pay period. In order to even be eligible to pre-designate, an employee must have health insurance to cover non-industrial injuries. If not, pre-designation will not be permitted.

Certain requirements must be met in order to properly pre-designate a personal physician under LC 4600(d). The employer must be notified of the pre-designation prior to the industrial injury. A "personal physician" may be either a person or a medical group, subject to certain requirements. A personal physician must be licensed under the Business and Professions Code. Chiropractors, psychologists and acupuncturists are not licensed and may not act as a personal physician for purposes of pre-designation.

A personal physician must have acted as the injured worker's primary care physician, treated the injured worker prior to pre-designation and agree to retain the injured worker's medical records. The personal physician must agree to the pre-designation. It is important to note that unless you consent to such communication, the employer cannot contact the pre-designated physician prior to the start of treatment either to confirm the pre-designation or to obtain your medical history.

Once you have properly pre-designated a physician, it is the employer's responsibility to provide authorization for the physician to treat, inform the physician of billing information, provide records pertaining to any prior treatment of the industrial injury, as well as where to fax treatment authorization requests. However, when it comes to the appropriate forms the personal physician is to use, the only requirement is that the employer directs the physician to the Division of Workers' Compensation website.

Historical Perspective

Legislative amendments to Labor Code (LC) Section 4600, effective on January 1, 1976, narrowed an employer's control to designate a treating physician to the first 30 days following the report of the worker's industrial injury. The injured worker was able to select the physician with whom he or she wanted to treat after the 30-day period. With the passage of Senate Bill (SB) 899 in 2004, the pendulum swung back in favor of employers. Changes included the implementation of Medical Provider Networks (MPNs). A new wave of changes came in 2012 with the passage of SB 863, which made it increasingly difficult for an injured worker to obtain treatment outside of the employer's MPN. Despite these changes, pre-designation survived.

Pre-designation when the employer does not have an MPN

If an employer does not have a Medical Provider Network (MPN), they can exercise medical control for the first 30 days following an employee's injury. Notice of the ability to pre-designate a physician must be provided to every new employee at the time of hire or by the end of the first pay period.

The injured employee can request a change of treating physician 30 days after reporting the injury. They can also treat with a personal chiropractor or acupuncturist, as long as they have informed their employer in writing prior to the injury. Similar to the requirements of a personal physician, such professionals must be licensed, have an established relationship with the injured worker, and agree to retain the injured worker's treatment records.

To designate a personal chiropractor or acupuncturist, the appropriate form can be found on the Department of Industrial Relations website. The same responsibilities outlined above concerning a properly designated personal physician also apply here. However, if the injury occurred on or after January 1, 2004, the employee will be limited to 24 visits. Additional visits are at the employer's discretion and must be authorized in writing.

Pre-designation when the employer has opted for a Health Care Organisation (HCO)

Some employers opt for a Health Care Organisation (HCO), which contracts with an employer to provide medical care. If your employer has an HCO in which you are enrolled, the employer will have medical control for the first 90 or 180 days, depending on the services the HCO provides. If your employer does not provide non-occupational health care, the period of control is limited to 90 days from the date you report the injury. If your employer does provide non-occupational healthcare, the period of control is extended to 180 days.

If you choose not to enrol in your employer's HCO, you may designate a personal physician, chiropractor, or acupuncturist. Every new employee must be given the option to enrol in the HCO or designate a personal physician, chiropractor, or acupuncturist 30 days following the date of hire. For current employees, the option to designate or enrol must be provided no later than 30 days before the end of the enrolment period.

Regardless of whether you pre-designate under LC 4600, LC 4601, or an HCO, all medical treatment and services within California's workers' compensation system are subject to pre-authorisation, with the exception of emergency services and treatment. A request for authorisation must be set forth on a Request for Authorisation Form and be completed by the personal physician, chiropractor, or acupuncturist.

It is beneficial to be treated by a physician who is familiar with your medical history and can create a more individualised treatment plan to speed up your recovery. However, this familiarity could easily become a disadvantage because the designated doctor must follow the same laws and regulations when requesting treatment as those providers within the MPN. Failure to do so can result in treatment delays or denials. Therefore, it is advisable to ask your pre-designated physician if they are willing to comply with the laws and regulations when requesting treatment. If your pre-designated personal physician is unwilling or unable to do so, the fact that they are pre-designated will be of little use as the treatment will likely be denied.

Pre-designation and the right to the title of Doctor

The title of Doctor, which originates from the Latin word of the same spelling and meaning, has been used as an academic title in Europe since the 13th century. In the United Kingdom, the title of Doctor is used for holders of doctoral degrees as well as for medical practitioners, except for surgeons. In the United States, the use of the title "Doctor" is dependent on the setting. The title is commonly used socially by physicians and those holding doctoral degrees.

In the context of pre-designation, the term refers to the process of selecting a physician in advance of sustaining a work-related injury. This process is particularly relevant for injured workers, as it allows them to have more control over their medical treatment. The concept of pre-designation was introduced through legislative amendments to the Labor Code (LC) Section 4600 in 1976, which gave injured workers the right to choose their treating physician after a 30-day period following the report of their injury.

Over time, the laws regarding pre-designation have evolved, with changes favouring either employers or employees. For example, the passage of Senate Bill (SB) 899 in 2004 shifted the balance towards employers by implementing Medical Provider Networks (MPNs). This meant that injured workers were required to seek treatment within their employer's MPN, making it more challenging for them to obtain treatment outside of this network.

Despite these changes, pre-designation has survived and remains an option for employees who wish to select their own physician in advance of an injury. This option is available under specific conditions, such as having health insurance to cover non-industrial injuries and properly notifying the employer of the pre-designation.

While the laws and requirements surrounding pre-designation may vary over time and across different jurisdictions, the fundamental concept remains focused on providing employees with a degree of choice and control over their medical treatment in the event of a work-related injury.

Frequently asked questions