CALIFORNIA WORKERS' COMPENSATION INFORMATION
Hurt at Work? Understand How Your Medical Care Works.
A free, plain-language guide to choosing and changing doctors, provider networks, treatment approvals, and medical evaluations in California workers' comp.
Fraud Warning
Making a false or fraudulent workers' compensation claim is a felony subject to up to five years in prison or a fine of up to $50,000 or double the value of the fraud, whichever is greater, or by both imprisonment and fine.
First Steps
Getting Medical Care After a Work Injury
In an emergency, call 911. Report your injury to your employer right away; California generally requires you to report a work injury within 30 days. Your employer must give you a claim form (DWC-1) within one working day after learning of the injury. Your employer's workers' compensation insurance generally covers medical treatment for a work injury. Ask your employer or its insurer how to get treatment under your claim.
Once you file the claim form, your employer generally must authorize up to $10,000 in treatment while your claim is being decided.
Choosing a Doctor
Who Chooses Your Doctor?
It depends on your employer's setup and whether you took certain steps before you were hurt.
If You Predesignated a Doctor
If, before your injury, you told your employer in writing that you want your own personal doctor to treat work injuries, and certain requirements were met, you may be able to see that doctor.
If Your Employer Has a Medical Provider Network (MPN)
Many employers use an MPN, a group of doctors approved to treat work injuries. You generally must get treatment within the network, but after your first visit you can usually choose a different doctor in the MPN.
If Your Employer Has No Network
Your employer generally chooses the doctor for the first 30 days after you report the injury. After that, you may generally switch to a doctor of your choice.
Ask your employer or its insurer which rules apply to you, and request written information about your MPN.
Your Treating Doctor
Your Primary Treating Physician
The doctor in charge of your care is called your primary treating physician (PTP). This doctor manages your treatment, requests approval for care, decides your work restrictions, and writes reports that affect your benefits.
Ask your treating doctor for:
- A copy of every work status report
- Your work restrictions in writing
- An explanation of any treatment that was requested
- A copy of your medical records
Provider Networks
Understanding Medical Provider Networks
Getting MPN Information
Your employer or insurer must give you information about its MPN, including how to find and choose doctors in it.
Changing Doctors in the Network
After your first visit, you can generally change to another doctor in the MPN.
If You Disagree With an MPN Doctor
If you disagree with a network doctor's diagnosis or treatment plan, you can generally ask for a second and third opinion from other doctors in the network, and then request an independent review.
If Care Isn't Available
MPNs must meet access standards. If you can't get timely care in the network, ask the insurer in writing, and contact the DWC Information & Assistance Unit for help.
Treatment Approvals
How Treatment Gets Approved
Step 1
Your Doctor Requests Treatment
Your treating doctor asks the insurer to approve specific care.
Step 2
Utilization Review (UR)
The insurer reviews the request using California's medical treatment guidelines and approves, changes, or denies it.
Step 3
Independent Medical Review (IMR)
If treatment is denied or changed, you can generally ask for an independent review. The deadline is short and is printed on the decision letter.
Some therapies, such as chiropractic care and physical therapy, may have limits on the number of visits. Ask your doctor or the insurer how this applies to you.
Medical Evaluations
Medical Evaluations in Disputes
When there's a disagreement about your injury, your ability to work, or your disability, a medical evaluation may be needed.
Qualified Medical Evaluator (QME)
A state-certified doctor who evaluates disputed medical issues. If you don't have an attorney, you can generally request a panel of three QMEs from the state and choose one.
Agreed Medical Evaluator (AME)
If you have an attorney, both sides may agree on an evaluator instead.
QME and AME exams are for evaluating disputes, not for ongoing treatment. The DWC Information & Assistance Unit can explain the process at no cost.
Your Rights
Your Rights During Treatment
Copies of Your Records
You can request copies of your medical records.
Mileage Reimbursement
You may be reimbursed for travel to and from medical appointments for your work injury. Keep a log of each trip.
An Interpreter
If you don't speak English well, you may be entitled to an interpreter at certain medical appointments. Ask in advance.
Protection From Retaliation
California law prohibits employers from retaliating against workers for filing a workers' comp claim.
Free Choice of Attorney
Your medical care and any legal help are separate. You never have to hire a particular attorney to get treatment, or see a particular doctor to hire an attorney.
Red Flags to Watch For
- Someone approaches you and offers to send you to a certain doctor or clinic, or a certain lawyer.
- You're offered money, gifts, or free transportation to see a particular provider.
- A clinic tells you that you must hire a certain attorney.
- You're asked to sign papers you don't understand.
Paying people to refer patients or clients is illegal in California. If something doesn't feel right, contact the DWC Information & Assistance Unit or the California Department of Insurance Fraud Division.
Important Deadlines
Workers' comp has time limits. Missing one can affect your care, so it helps to know them early.
Report your injury
Generally within 30 days of the injury — sooner is better.
File your claim form (DWC-1)
Generally within one year of the date of injury.
Ask for Independent Medical Review
The deadline is short and is printed on the Utilization Review decision letter.
Respond to QME panel letters
Letters about medical evaluations often include short deadlines. Read each one as soon as it arrives.
Deadlines can vary with your situation. Keep every letter you receive, and contact the DWC Information & Assistance Unit if you're unsure.
Free Official Help
Where to Get Free Help
These official California resources are free to use. They are government agencies, not affiliated with this website.
Questions
Frequently Asked Questions
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