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  1. #1
    Join Date
    Apr 2014

    Default If I Can't Find a Local Work Comp Doc, Can I Use Medicare Doc California

    My workers compensation claim was made in the State of: California. This is for my husband. He is a paraplegic as a result of a work injury with lifetime medical from the workers compensation carrier. Unfortunately, it is not always easy to find a local doctor who accepts workers compensation. He does have medicare because of his disability. Can I have him see a medicare doctor and let medicare determine, if they like, that the care was work-injury related and let them go after the work comp carrier for payment? I am just trying to get him the care he needs.

  2. #2
    Join Date
    Oct 1971

    Default Re: If I Can't Find a Local Work Comp Doc, Can I Use Medicare Doc California

    You can't bill Medicare for a work related injury.
    It's your adjusters job to find a doc to treat your husband, call them and ask for help.
    If at some point, your husband settles his case, he'll have to inform Medicare and set up a Medicare Setaside fund.

    Moderator Responses are based on my personal bias, experience and research - They do not represent the views of the admin nor may be accepted in the legal community, always consult an attorney.

  3. #3
    Join Date
    Jan 2012

    Default Re: If I Can't Find a Local Work Comp Doc, Can I Use Medicare Doc California

    I realize this is a very old thread. For the sake of those in the future who might be reading/learning, I have a couple suggestions for an IW in California in the thread-starter's situation of having a hard time finding doctors who will accept work comp patients.

    Per CA work comp laws regarding the Medical Provider Networks (MPNs), if the MPN does not have 3 different doctors within a specified distance who will see an IW, that IW can seek a judge's order to be able to treat with a doctor outside the MPN in that field of medicine (and the work comp insurance company must pay for it). The 3 doctors must be within 15 miles or 30 minute drive if a PTP, and within 30 miles or 1 hour drive if a specialist. (I would also double check distances that an MPN website might claim that the doctors are from your location.)

    If you want to go outside the MPN, call all doctors listed in that particular field on the MPN and ask if they accept work comp patients or not. When I phoned doctors on my IC's MPN website, there were doctors names listed that no one at the phone number/clinic had ever heard of, doctors listed in incorrect fields of medicine, doctors who hadn't accepted work comp patients for many years, etc. I suspect the MPN website was trying to make it look like they had more MPN providers than they truly had.

    Also, if your case settled with the medical kept open and you had an attorney, your attorney is legally bound to still represent you even after the disability portion of the case was settled. They should help you get the medical care you were promised.

    Insurance companies don't generally want IWs treating outside the MPN because the non-MPN doctors might request more care than an MPN doctor. Depending on the cost of an MSA (if required), and if you would prefer to have the medical settled, seeking approval to go outside the MPN for care can potentially be an incentive for the IC to settle the medical rather than leaving it open.

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