RateFast Definitions: PTP (Primary Treating Physician)

A PTP is the Primary Treating Physician of a workers’ comp claim. When an injured worker’s claim is approved by an insurance company, they are either assigned or given a choice of a physician who will provide care, request treatment, and recommend specialists for examinations during the claim. The PTP also has the job of writing the impairment and permanent stationary reports for the claim, which determines how money the worker is compensated.

The PTP is a physician that is within the MPN (Medical Provider Network) of the insurance company. Generally, an insurance company will assign a PTP to a worker based off of proximity and specialty in relation injury.

If you are a worker who was recently injured and are confused or have questions about the workers’ compensation system in California, see part 1 and part 2 of the Worker’s Guide to Worker’s Comp series.

Specialties of PTPs

A PTP can be a general practitioner, which is a doctor who treats patients with injuries anywhere in the body. These PTPs may see one patient who has an injury in their shoulder, while helping another patient recover from PTSD, from another claim.

Other PTPs are specialists in a particular part of the body, like an orthopedist. The orthopedic PTP will see a patient who has had a spinal injury, which needs specific knowledge to effectively treat. While this PTP might be able to treat a patient with deep-lung burns from a chemical spill at work, they might prefer the patient see a PTP with more experience in these types of injuries.

Options of PTPs

A PTP is a position which a physician must be certified for in order to treat patients in workers’ comp claims. This means that an injured worker cannot see their family doctor or primary care provider for their work comp claim.

If you are a physician interested in getting started with workers’ compensation, check out this blog post.

As mentioned above, the PTP is assigned from within the MPN of the employer’s insurance company. The MPN is a list of physicians that the insurance company assigns to workers. Generally, an injured worker cannot see a PTP outside of the insurance’s MPN.

When a workplace does not have workers’ compensation insurance, the injured worker may be entitled a PTP and more through the Uninsured Employers Benefits Trust Fund.

The Injured Worker and the PTP are a Team

It’s the goal of the injured worker and the PTP to get the worker compensation that is equal to the injury, as it is written in the state’s workers’ compensation rule set and fee schedule. The PTP must trust that the worker is giving a complete, accurate, and honest account of the injury as they are experiencing it, including pain and how the injury affects their ADLs. By the same token, the injured worker must make sure that their PTP is caring for their injury well, and that they are writing full and correct reports in order to get the equal compensation for the injury.

If the injured worker feels that their PTP isn’t doing their job well, they are entitled to changing their PTP to another one in the insurance’s MPN. A worker can choose another PTP for other reasons as well, including being too far away.

Conclusion

A PTP (Primary Treating Physician) is the doctor that is assigned to the worker who helps the worker receive their treatment and compensation equal to the severity of the injury. They work together to tell the insurance company how bad the injury is, and how it’s healing. If the worker is not satisfied with the PTP, they can switch to another through their insurance company.

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