If your California employee was injured, or claims to have been injured on the job, they may want to visit with their own doctor or medical professional. While they are welcome to do so, they generally must also visit with an in-network doctor. Indeed, many workers comp insurance carriers include a Medical Provider Network (MPN) in their provision of services to their insureds and the insured employees. Unless an employee has specifically elected to be treated by their personal physician in writing, and only if the designated physician has agreed to provide medical care for worker’s compensation injuries and illnesses in writing and the designation was made prior to the injury or illness, an injured employee must treat within the medical provider network.
Not surprisingly, many workers’ compensation disputes arise because the injured employee disagrees with the treatment recommended or provided by the doctor in the medical provider network. Often, the insured claimant will see another medical provider who may recommend a different treatment or disagree with the diagnosis altogether, causing a legal and medical dispute with the injured employee. The quality and accessibility of the medical provider network is a factor an employer should consider when selecting an insurance provider.
Disputes between the employee and the employer regarding workers comp coverage are not uncommon. It is not advisable for an employer to engage with the employee without the guidance of an experienced workers comp defense attorney.
Workers comp disputes
Common reasons disputes arise between the employer and employee include:
· the causation of the injury,
· the amount and type of treatment needed,
· the level of disability.
If a dispute should arise over the place of the injury (whether the injury actually happened at work), whether the employer was grossly negligent, whether the injury was intentionally caused, or whether the injured employee or another employee was involved in a criminal act at the time of the injury, an employer will likely want to retain experienced legal counsel. It is important for an employer to note that while workers’ compensation insurance is considered no-fault insurance, exceptions do exist. Workers comp insurance providers have been known to deny coverage in some situations, or under certain circumstances, and the business may have a claim for bad faith against the insurance provider.
For more information on bad faith actions by workers comp insurance providers and how to defend your business against them, contact experienced workers comp attorney Drew E. Pomerance today.