UESF News Each school year, we remind you of your rights to use your own doctor if
you are injured on the job AND if you have filed a request with the District's benefit office. If you do
not have a form on record, you must use the Workers Compensation medical facilities at San Francisco General for at least the
first thirty days of treatment.
Your letter to SFUSD should state simply that you wish your doctor (name the person or health plan) to be
your primary care provider in the event of a work-related injury. Deliver that letter to the benefits office.
Keep a dated and stamped copy for your records.
Below, posted with permission, is an article from Julius Young, attorney at law. Most important person in
the workers' comp system is treating physician
No one wants to think that they will be injured at work. But injuries do happen,
and workers are well advised to take steps to protect their interests in the event
of industrial injury. Should you be injured at work, the most important person in
the workers' compensation system is your treating physician.
Except in cases where
an injury is denied in the first place, the treating doctor's opinion is presumed
to be correct. Among the issues subject to this rebuttable presumption are issues
of your returning to work, temporary disability payments, need for continuing
treatment, need for vocational rehabilitation and monetary compensation for
residual permanent impairments. Should issues about your entitlement to benefits
go to a judge for decision, the judge will probably pay special attention to your
treating doctor's reports.
Many workers find that the care from company designated "doc in the box" industrial
clinics is impersonal, unsympathetic, and even downright substandard. Many company
doctors and company designated clinics have cozy relationships with employers which
make it difficult for the injured worker to get top flight care. In some cases it
appears that employers bring pressure on
company designated clinics, interfering with the normal doctor patient relationship.
A call from the claims examiner or the employer to the company clinic may result in
the worker being released to work prematurely (or in some cases, held off work or forced
into retraining unnecessarily). A call from the claims examiner to the company doctor
accusing the worker of being "a fraud" may severely prejudice the worker's treatment.
Video surveillance of the employee may be shown to an unsympathetic company doctor who
then dismisses the worker's pain.
Maintain control to avoid premature return, unnecessary retraining...
In order to be treated by a doctor of your choice within the first 30 days of injury,
you must designate your choice of physician in writing before your injury occurs. This means
you should put a written statement in your personnel file designating your "personal physician" now.
The statement can be very simple, merely specifying the doctor you choose.
If you sustain an industrial injury, you can then begin treating with that personal physician
immediately following your injury. Note that the physician you designate could be (but need not be)
your regular doctor or family doctor that you see under your regular group medical or HMO plan.
Or it could be some other doctor you have seen before or some doctor or facility you think you would choose to see if you were hurt. (A treating physician under California Workers' Compensation may be a medical doctor, a doctor of chiropractic, or a licensed acupuncturist.)
What if you have not predesignated a doctor in writing before your industrial injury?
You will be forced to treat with your employer's doctor for at least 30 days following
the injury. Although a provision exists to change doctors within 30 days, it is a difficult
and seldom used procedure.
After the first 30 days of injury you can designate a doctor of your choice even
if you have not predesignated a doctor. Insurance companies frequently contend that the
injured worker only gets one change of treating doctors. Not so. In a 1995 case, Ralphs
Grocery v. WCAB, the California Court of Appeal made it clear that under Labor Code 4600
California injured workers actually have the right to change doctors more than once.
The courts have noted that if an employer concludes the employee is doctor shopping
and abusing the right to choose a treater, the insurer's remedy is to allow the requested
change of doctors and then (under Labor Code 4603) to petition the administrative director
of the Division of Industrial Accidents for an order allowing the insurer to designate a
new list of doctors from which the worker would be forced to choose.
Keep in mind that your treating doctor's assessment of your disability status
and opinion as to what medical tests, treatment and medication you need will be
presumed correct. Having a sympathetic and competent doctor on your side who will
advocate for your interests is a major plus for any injured worker. Having the injured
worker in control of his or her medical care is the watchword for workers' comp these
days! Act now and avoid hardship later: pre-select a doctor for any work injuries!
Workers' Comp:
Designate treating physician before you are injured
by Julius Young, attorney at law, Boxer & Gerson, Oakland
So how can this be avoided? The key is for the worker to maintain control of medical treatment.
Although an injured worker can "self procure" treatment at any time with any doctor, such
treatment will not be paid for by the workers' comp insurer except in extreme circumstances.
To have doctor bills paid by the industrial carrier, certain procedures must be followed.
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