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work comp

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msfrustrated

Junior Member
What is the name of your state? california

the company dr sent me back to modified work and my dr has not but work comp has stopped my payments is this right??????????????????? :confused i ALSO forgot to add that the company dr has not declared me " permanent and stationary "
 
Last edited:


ewctalk

Junior Member
Well, yes. In a CA WC claim there really shouldn't be "my Dr" and the "company Dr". As of 1/1/05 Ins companies may become approved for a MPN-medical provider network. Most companies utilize a pre-organized network like First Health rather than going out and writing their own contracts with each individual dr. or facility throughout and area or the state. There are only 4 times when you, as the injured worker, can remain treating outside the MPN (if the Ins. company has been approved by the state). They are: an acute condition that involves a sudden onset of symptoms that requires prompt med attention of limited duration; a serious, chronic condition that is serious in nature and persists or worsens over an extended period or requires ongoing treatment to maintain remission or prevent deterioration; a terminal illness that is incurable or irreversable; or a planned surgery or other procedure authorized by the insurer that will occur within 180 days of the contracts termination date.

Most employers are going to refer you immediately to an MPN provider and that's where you should stay. If you go to "Your Dr." they will very likely not pay for the treatment.

You can head this off ahead of time by completing the predesignation form before an injury occurs. there's restrictions on that too. Your employer must offer regular health insurance and your personal doctor (whom you've seen before and knows your med history) agrees to be your predesignated Dr. for work-related injuries. He/She must sign & date the form. Those are the main criteria.

The company Dr. likely released you to return to work with restrictions. If your employer cannot accommodate them then you stay home and continue to be paid. If they can accommodate then you should return to work. Both you and the insurance company have the right to object to any report and get another opinion essentially. This is called the Panel Qualified Medical Evaluation process. I wouldn't rush into that process just yet. You should see if their dr. has released you back to work full duty-no restrictions or for modified duty. Then you should go back to work and adhere to those restrictions. If its not working out in your opinion you need to set an appt to go back to see the dr asap and address your concerns with him.

Lastly, you can always bounce any of this off an Information & Assistance officer in your are. Since you stated you'd received TD benefits you've undoubtably received a letter entitled Notice Regarding Temporary Disability Benefits, Status of PD benefits and/or Potential Rights to Supplemental Job Displacement Benefits Voucher. On there, probably about page 3, there's required language about calling them if you have questions or you may contact your local Info & Assistance office and they should give you a local or semi-local # to call. The I&A officers are extremely knowledgable and can give you unbiased advice on what you can and can't do and if something is unclear to you. Hope this helps.
 

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