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Your Medical Rights in California Workers’ Compensation Cases

  • Writer: WCWCA Editorial Team
    WCWCA Editorial Team
  • Nov 28, 2025
  • 3 min read

When you’re injured at work, understanding your medical rights in California workers’ compensation is essential. Insurers often delay or deny treatment, especially for first responders dealing with complex injuries. Knowing your rights ensures you receive proper, timely care.



What Medical Treatment You’re Entitled To


California Labor Code §4600 guarantees injured workers all treatment reasonably required to cure or relieve the effects of a work injury.


You are entitled to:

  • Doctor visits

  • Imaging & diagnostics

  • Surgery

  • Physical therapy & chiropractic care

  • Mental health treatment

  • Medication

  • Mileage reimbursement

For more information, refer to the official California Labor Code §4600 Document.



Your Right to Choose a Doctor


If your employer has an MPN (Medical Provider Network):


You must choose a doctor within the network, but you can:

  • You may change doctors at least once

  • You may seek a second and third opinion if care is inadequate

  • If still unresolved, you may request an Independent Medical Review (IMR)

  • In certain cases, IMR allows treatment outside the MPN

You can visit the official California Medical Provider Network page for more information.


If your employer does NOT have an MPN:


You may choose any qualified physician as your Primary Treating Physician.

If your employer refuses to give you a claim form or treatment: What to Do When Your Employer Refuses Treatment.



Your Right to a QME (Qualified Medical Evaluation)


When disputes arise, a QME is used to resolve issues such as:

  • The cause of your injury

  • Whether treatment is necessary

  • Whether you have permanent disability

  • Your work restrictions

  • Future medical care



Also refer to the Official DWC QME FAQ.



Your Right to Timely Medical Treatment


California law requires:

  • Treatment within 1 business day after filing your DWC-1 claim form

  • Insurance must authorize up to $10,000 in medical treatment while investigating your claim

If your care is delayed, it may violate state law.



Your Right to Fight Delayed or Denied Care


Treatment denials typically occur through Utilization Review (UR). If UR denies your care, you may request Independent Medical Review (IMR) — a neutral medical expert decides whether the treatment is medically necessary.


IMR often overturns improper denials, especially in first responder cases.



Enhanced Medical Rights in California workers’ Compensation for First Responders


Firefighters, police officers, and EMTs benefit from presumptive injury laws, which make it easier to obtain medical treatment for:

  • Cancer

  • Heart conditions

  • Pneumonia

  • Bloodborne illnesses

  • Hernias

  • PTSD under SB 542

  • Meningitis

Learn more about these special protections:

These laws shift the burden of proof OFF the worker — a major advantage.



If Your Medical Rights Are Violated


You may need legal help if:

  • Care is repeatedly delayed

  • Treatment is denied without reason

  • You are pressured into seeing insurance-friendly doctors

  • Your doctor fails to document your injury properly

  • You’re prevented from switching physicians


WCWCA assists with:

  • Doctor selection

  • QME management

  • Fighting denials

  • Ensuring compliance with California law

  • Protecting future medical care




Contact WCWCA


Understanding your medical rights in California workers’ compensation cases is crucial to receiving proper care and protecting your legal benefits. If you feel your treatment is being delayed, denied, or mishandled, you do not have to face the system alone.


WCWCA ensures you receive the care, documentation, and legal protection required to heal and move forward. Call 415-218-5634 or visit our Contact Page.


“This article was prepared by the WCWCA team and reviewed by Brittany Huynh.”



 
 
 
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