Workers' Comp Medical Care in California (2026 Guide)

What medical care does workers' comp cover?

California workers' comp covers every treatment that is reasonable and needed to cure or relieve a work injury: doctor visits, surgery, physical therapy, medicine, MRIs, and equipment. Injured workers pay $0 in copays or deductibles, and mileage to visits pays 72.5 cents per mile in 2026.

The rule comes from Labor Code 4600. Your employer must pay for all care that cures or relieves your injury. That covers the emergency room, the surgeon, the physical therapist, and the pharmacy. It also covers braces, crutches, and home care when a doctor orders them.

Start at the emergency room if the injury is serious. Tell the staff you were hurt at work. Give your employer's name. The bill goes to the workers' comp insurer, not to you.

Doctors must follow the MTUS. That stands for Medical Treatment Utilization Schedule. It is the state's rulebook for care. It lists the right treatment for each type of injury. Requests that match the MTUS should get approved.

What if your claim is still under review? Care starts anyway. Labor Code 5402 gives the insurer 90 days to accept or deny your claim. During that window, it must authorize up to $10,000 in treatment.

Here are the medical care numbers every injured worker should know.

Track your miles from day one. Write down each trip to the doctor, the pharmacy, or therapy. Send the log to the claims adjuster for repayment.

Who picks your workers' comp doctor?

Most California employers use a Medical Provider Network, a list of insurer-approved doctors that controls treatment for work injuries. You can keep your own doctor only if you named that doctor in writing, before the injury, under Labor Code 4600(d).

The network is called the MPN. Labor Code 4616 lets insurers build one. The insurer picks the doctors and pays them. Your first visit usually goes to an MPN clinic your employer names.

Why does this matter so much? Your treating doctor runs your claim. That doctor sets your work restrictions. That doctor decides if you get disability checks. That doctor requests your surgery. The right choice changes everything.

There is one way to keep full control. Pre-designate your personal doctor before you ever get hurt. Put it in writing and give it to your employer. Labor Code 4600(d) then lets your own doctor treat you from day one.

Pre-designation has three rules. You need group health insurance through work. Your doctor must have treated you before and hold your records. And your doctor must agree in advance. Most HR offices keep a one-page form for this. Fill it out this week, even if you feel fine.

Company clinics can feel rushed. Five-minute visits. Light-duty slips that ignore your pain. If that sounds familiar, use the switching rights below.

Can you switch doctors inside the MPN?

Yes. After the first visit, an injured worker may switch to any doctor on the MPN list at any time, with no permission needed. Workers who dispute a diagnosis or treatment plan may also get a second and a third opinion inside the network.

You are not stuck with the company clinic. Ask the adjuster for the MPN list. Or search the insurer's MPN website. Pick a doctor you trust. Then tell the adjuster in writing and keep a copy.

Choose with care. Look for a specialist who fits your injury. A spine doctor for a back injury. An orthopedic surgeon for a torn shoulder. A hand specialist for carpal tunnel. Read reviews and ask about wait times.

Picture a warehouse picker with a hurt back. The clinic hands her ibuprofen and a full-duty slip. She switches to an MPN spine specialist. The new doctor orders an MRI and real work restrictions. Same network, very different care.

Disagree with your doctor's plan? Use the second and third opinion process. You may see two more MPN doctors about the disputed treatment.

The network must also give you real access. It needs doctors and specialists near your home or job. If the MPN lacks the specialist you need, you may get to treat outside it. A lawyer can push that issue for you.

What happens when utilization review denies treatment?

Utilization review is how insurers deny or cut back requested care. A denied worker has 30 days to appeal through Independent Medical Review, a free state process where an outside doctor decides. The denial letter includes the appeal form.

Utilization review, or UR, is the insurer's checkpoint. Labor Code 4610 lets a review doctor approve, delay, change, or deny each treatment request. That reviewer never examines you. Denials often turn on missing paperwork, not on your real needs.

Why do denials happen? The reviewer checks each request against the MTUS rulebook. Thin chart notes sink good requests. A detailed report from your doctor, tied to the guidelines, gives the request its best chance.

A denial is not the end. You can demand Independent Medical Review, or IMR. Labor Code 4610.5 gives you 30 days from the denial to file. The state then assigns a neutral doctor to review your records and decide.

This table shows the treatment fight from start to finish.

Protect your appeal. Keep the denial letter and its envelope. Ask your treating doctor to send records that support the request. Then file the IMR form right away. Miss the 30 days and the denial usually sticks.

Medical care runs on deadlines. This table puts the big ones in one place.