What Is California Labor Code §4616.3: Second and Third Opinions?

If the covered employee disputes either the diagnosis or the treatment prescribed by the primary treating physician or the treating physician, the employee may obtain a second and third opinion from physicians within the MPN. During this process, the employee is required to continue his or her treatment with the treating physician or a physician of his or her choice within the MPN.

What Is California Labor Code 4616.3?

Section 4616.3 lets you get a second opinion inside your MPN, and a third one if you still disagree with your treating doctor.

Most injured workers in California must treat inside their employer's medical provider network, called an MPN for short. Labor Code 4616.3 is the part of that network law that protects your medical judgment once you are inside it. If you think your treating doctor has the wrong diagnosis, or the wrong treatment plan, this law lets you ask for a second doctor's view from the same network. If you still disagree after that, it lets you ask for a third opinion too.

The right applies to any covered employee who is treating inside a valid MPN and disputes the diagnosis or the treatment the treating physician has prescribed. You do not have to leave the network to use it, and you do not have to stop your care while you wait for the next opinion. Eman Yazdchi is a Certified Specialist in workers' compensation law, certified by the California Board of Legal Specialization, State Bar of California.

How do you start a second opinion request?

Tell the contact named for MPN questions that you dispute the diagnosis or treatment, then pick a doctor from the MPN list you receive.

Start by telling the person in charge of network questions for your claim. You can do this in writing or out loud. Say that you dispute your treating doctor's diagnosis or treatment and that you want a second opinion.

Your employer or insurer must then give you a list of other network doctors, grouped by specialty, who can treat your type of injury. Pick a name from that list. Book an appointment, and tell your contact the date you booked.

Your employer or insurer has its own duties too. It must send your medical records to the new doctor before your visit, tell that doctor why you disagree with the first opinion, and give you a copy of the records if you ask for one.

What deadlines apply to the second and third opinion process?

You get 60 days to book each opinion visit, and the opinion doctor then has 20 days to send a written report.

Two clocks matter most. You must book your opinion appointment within 60 days of getting the doctor list. Miss that window, and you are treated as having given up the opinion for that specific dispute. The same 60 day rule applies if you move on to a third opinion.

Once you are seen, the opinion physician has 20 days from the appointment, or from getting any test results, whichever is later, to send a written report. A copy goes to you, to your MPN contact, and to your treating doctor.

What happens if you still disagree, or a doctor's specialty does not fit?

A mismatched specialist gets you a new list, and ongoing disagreement after the third opinion can move to an MPN IMR.

Sometimes the opinion doctor reviews your records and decides your injury is outside what they treat. When that happens, your employer or insurer must send a new list so you can pick someone else. The same rule applies at the third opinion stage.

If you disagree with the second opinion doctor too, you do not have to accept that view. You may ask for a third opinion from a different network doctor. The request works the same way: tell your contact, pick a name from the new list, and book the visit within 60 days.

Once an opinion doctor recommends treatment, you must be allowed to get that care inside the network, or outside it within a reasonable distance if no MPN doctor can provide it. You can change to the second opinion doctor, the third opinion doctor, or another network doctor to get that care.

If you still disagree with the third opinion doctor's diagnosis or treatment, you may file a request with the Administrative Director for an MPN Independent Medical Review. A physician is then picked at random to decide the dispute from your records.

This step is not the same thing as the Independent Medical Review many workers hear about after a denied treatment request. That other review follows a Utilization Review denial under Labor Code 4610 and Labor Code 4610.5, and it asks whether a specific treatment is medically necessary. The review tied to this statute instead asks whether the network doctor's diagnosis or treatment choice was right. 4616.3 sits inside the broader medical provider network law, which creates the network itself.

What should you save before you ask for a second opinion?

Write down your dates, keep your paperwork, and ask for written confirmation of your request.

• The date you received the list of available doctors.
• The date of your appointment and the doctor's name and specialty.
• Copies of the opinion doctor's written report and any test results.
• Notes on when and how you told your MPN contact about the dispute.

If you never named a personal doctor in writing before you were hurt, the predesignation rules likely will not help your claim, and the second and third opinion process is your main tool for a doctor dispute. A real file that used this process to move a stalled claim forward is described in this MPN second opinion case study.

Get help with an MPN diagnosis or treatment dispute

A review of your MPN paperwork can show whether the second and third opinion deadlines were followed correctly.

If your network doctor will not order the test or treatment you believe you need, do not wait and hope the next visit goes better. Yazdchi Law P.C. reviews each potential case individually before deciding whether to take it on. Call (661) 273-1780 or use the contact form to go over your MPN list, your dates, and your doctor's notes.