Workers' compensation FAQ — plain answers to 24 common questions

It depends on your state and whether your employer uses a Medical Provider Network (MPN). In states with MPNs, your first treating physician is usually chosen from the MPN list. After a 30-day waiting period (in California), you may be able to switch within the MPN. In non-MPN states, you usually have more choice from day one. Check your employer's posted notice or ask your claims adjuster which rule applies.

Start with your employer's MPN list, if one applies. If you don't have an MPN list, you can search this directory by city, specialty, or network — every listing shows whether the provider is currently accepting new WC patients. Call the office before booking to confirm they're still accepting new claims under your specific MPN or carrier.

For the first 30-90 days after injury (varies by state), your employer or carrier can usually require you to start with a designated provider. After that window, you generally have the right to choose your own treating physician — sometimes within the MPN, sometimes from any qualified WC provider. If you're being pressured to stay with a provider you're unhappy with, talk to your claims adjuster or a WC attorney.

Call the practice's front desk and ask specifically for the WC scheduling coordinator. If you still don't get a callback within 1 business day, email your claims adjuster — they have a contractual obligation to ensure timely access to care. As a last resort, contact your state's WC board to file an access-standards complaint. Document everything in writing.

Yes — most MPNs let you switch to any other in-network provider once without prior approval. Subsequent switches may require justification. Notify your claims adjuster in writing whenever you change providers. If you're switching because the provider isn't responsive or the care isn't working, document the specific issues — that history matters if your claim is disputed later.

An MPN is a network of medical providers contracted with your employer's WC insurance carrier (or with the employer directly, if self-insured) to treat workplace injuries. If your employer uses an MPN, you typically must choose your treating physician from that network — at least for the first 30+ days. MPN rules and timelines vary by state; California has the most formalized system, others vary widely.

Call the provider's office and ask the front desk to verify active participation in your specific MPN (give them the carrier name and MPN ID if you have it). Cross-check with your claims adjuster before the appointment. MPN rosters change between updates, and a provider listed today might exit the network before your visit.

The insurer may deny payment for the visit, and you could be left with the bill — or the visit may not count toward your treatment record. Always confirm network status first, or request prior authorization in writing for an out-of-network referral. If your MPN doesn't have a needed specialist within reasonable distance, the carrier must authorize an outside referral.

The insurance carrier (or self-insured employer) pays the provider directly under your state's WC fee schedule. You should NOT be billed for covered treatment. If you receive a bill, contact the claims adjuster immediately before paying anything. Co-pays and deductibles do not apply to WC visits.

Yes, employers and carriers can change MPN administrators mid-claim. You must be given written notice and a chance to either transition to an in-network provider in the new MPN or continue with your current physician under specific transition-of-care conditions (which vary by state). If a change is announced, request the transition rules in writing.

A QME is a state-certified physician who performs independent medical-legal evaluations in disputed workers' comp cases. In California, when there's disagreement about your diagnosis, treatment, or impairment rating, a QME panel is generated and you (or both sides) select an evaluator. QMEs must complete state certification and meet ongoing CE requirements. Most other states use a similar IME-style mechanism with different terminology.

QME = Qualified Medical Evaluator, chosen from a state-generated panel when sides can't agree. AME = Agreed Medical Evaluator, chosen jointly by the applicant attorney and defense, used in represented cases. AMEs are typically used when both sides trust the same physician's judgment; QMEs are used when no joint pick is possible. AME reports tend to carry more weight in settlement negotiations.

Yes — refusing a QME appointment in California typically results in suspension of your indemnity benefits. If the time or location doesn't work, you have 10-30 days (varies) to request a rescheduling in writing. Bring photo ID, your claim number, and any prior records the QME requests. Be honest and thorough — QME reports are heavily weighted in claim decisions.

QME reports are generally valid for the duration of the dispute they were generated to address. If new evidence emerges (new diagnosis, additional injury, treatment response), a re-evaluation can be requested. In permanent disability cases, the QME report's impairment rating is typically the controlling document at settlement.

Bring photo ID, your claim number, the claims adjuster's contact info, the employer's First Report of Injury (if you have it), a list of current medications, and any prior medical records related to the injury. Many providers also accept faxed or emailed records in advance. Arrive 15 minutes early to complete intake paperwork.

Five key questions: (1) What's your assessment of the injury and treatment plan? (2) Will you write me out of work or assign modified duty — and for how long? (3) What's the next visit and any imaging you're ordering? (4) Do you accept my employer's MPN? (5) How does your office handle disability paperwork and claim documentation? Ask them to write a brief summary to give to the claims adjuster.

Yes — a family member, friend, or attorney can attend the visit to take notes and help you remember the conversation. They can also help advocate if the provider is rushed or unclear. The provider may ask the support person to step out during the physical exam.

The provider documents the visit and sends a report to the claims adjuster within a few business days. Treatment authorization for follow-ups, imaging, or therapy may require utilization review (UR) — that can take 5-14 days. If authorized care is denied, you have appeal rights through Independent Medical Review (IMR) in California, or through your state's equivalent process.

No — under workers' compensation, you pay nothing for medically authorized care. The insurance carrier pays the provider directly under the WC fee schedule. No co-pays, no deductibles, no out-of-pocket cost. If a provider tries to bill you for a covered WC visit, contact the claims adjuster immediately before paying anything.

Tell the provider before you accept the release. Be specific about the activities and movements that still cause pain. If you disagree with a full return-to-work release, you can request a second opinion, ask for a QME (in California), or contact your claims adjuster. Document everything — your description of symptoms is part of the medical record.

Until you reach Maximum Medical Improvement (MMI) — the point where additional treatment isn't expected to materially improve your condition. After MMI, you may receive a permanent disability rating and a settlement offer. Your treating physician determines MMI; if you disagree, you can request a second opinion or QME evaluation.

Don't panic — claim denials are appealable. Request the denial reason in writing from the carrier. In California, you can file an Application for Adjudication of Claim with the WCAB and request a hearing. Consult a WC attorney for represented cases — most charge no upfront fee (their fees come from any settlement, capped by state law). Document everything from the date of injury forward.

Yes, with proper authorization. Most WC cases include physical therapy and chiropractic care in the treatment plan when medically indicated. Authorization is typically issued by the treating physician and approved by the carrier. Each state limits the number of chiropractic visits per injury (California: 24 visits without further authorization).

Records related to your WC claim are shared with the carrier, claims adjuster, and (if represented) attorneys on both sides — that's part of the claim process. Records about unrelated medical issues do NOT have to be shared. If the carrier requests broader records, you can object in writing and request the records be limited to the body part or condition under claim.