Authorized Medical Care Provider

An authorized medical care provider is approved and authorized by the workers' compensation insurance company to provide medical care to an injured employee after a work-related accident or illness. Workers who are injured should discuss their medical care options with their employers. Most states will provide a list of medical providers that are authorized to provide authorized medical care for workers' compensation claims within their state.

Failure to follow your state's laws when getting medical care for a work comp claim or seeking medical care from a medical doctor who is not approved or authorized by the insurance company can seriously hurt your claim or result in a claim denial.

Health care providers who are authorized to provide medical care for workers' compensation claims must comply with the workers' compensation statutes and rules in the state. Services must be authorized by the insurance company and medically necessary to treat the medical condition of the employee. The provider must also “provide all necessary medical documentation, records and reports to support the medical necessity of the treatment rendered and communicate to the insurance company the medical condition of the injured employee.”

How do I find a Authorized Medical Care Provider?

Injured employees can discuss their options with their employers. In the state of California, for instance, there is a medical provider network (MPN) which is established by the insurance company. Each MPN includes doctors specializing in work-related injuries and doctors with expertise in general areas of medicine. Employees may choose their doctors from this choice of providers. In California if the injured worker does not agree with the diagnosis or treatment from their chosen doctor they may seek a second opinion. Subsequent disagreements are handled by an independent medical review (IMR).