Maintaining Medical Control, MPN Notification, Enrollment, and Predesignation

Many of my clients come to me because something is broken in the way they handle their Workers’ Comp claims. They come to me when they have an out-of-control experience mod and their costs are beginning or already hitting their profit margins.

Ultimately, I am trusted to look at their claims history and investigate what went wrong. When I do this, I nearly always find that the problem claims are the ones that the client lost medical control of, either immediately upon reporting of the claim or shortly thereafter. These claims “jump out” of the Medical Provider Network or MPN of the insuring company. I should say, they are allowed to jump out and the claimants usually seek immediate representation, and the claims seem to drag on forever, because the attorney gets paid on a percentage of the cost of claim, and the non-MPN physician has a tendency to “over-utilize” (nice way of putting it).

WHAT ALL EMPLOYERS SHOULD DO TO MAKE SURE THEY RETAIN MEDICAL CONTROL.

MPN’s are designed to save the insurance company and through them, the Employer money. The procedures for MPN notification, Enrollment, and Predesignation (opt-out) are clear; they just are not being used by many employers. This is a shame as it is one of the only advantages the employer has in this system. The following must be done at time of hire, or any time that the employer changes carriers (thus changing MPN).

In order to maintain control and keep the claim in your MPN you must get the following from your broker or insuring company:

1) Employee Implementation Notice of MPN

2) Acknowledgement of receipt of MPN Information

3) Initial Written Employee Notification RE: Medical Provider Network – (English version)

4) Initial Written Employee Notification RE: Medical Provider Network – (Spanish version)

Then, to properly enroll your employees you must:

1) Provide all employees with a copy of the Employee Implementation Notice.  This notice will need to add their Name and MPN Effective date prior distribution to employees.

2) Include copies of the Employee Implementation Notice of MPN in new hire information

3) Have every employee verify receipt of the Employee Implementation Notice of MPN. (Always keep copies of these receipts in the employee’s personnel file, or a master file set up for this purpose)

4) Complete and return the MPN Implementation Verification Form to the insurance carrier or Third Party Administrator responsible for claims.

5) Post the Initial Written Employee Notification RE: Medical Provider Network, both in English and Spanish, in a conspicuous location frequented by employees during the work day hours and in close proximity to the workers compensation posting notice (DWC7 Notice to Employees-Injuries caused by Work). The Initial Written Employee Notification RE: medical Provider Network should also be provided to employees at time of injury.

During the enrollment process, the employee will also be given the opportunity to “pre-designate” their own personal physician to treat a work-related injury. Pre-designation could be a red flag!  They can pre-designate their personal doctor of medicine (M.D.) or doctor of osteopathy (D.O.) only if: the employer offers group health coverage; the doctor has treated the employee in the past and has their medical records; prior to the injury the doctor agreed to treat them for work injuries or illnesses and; prior to the injury they provided the employer the following in writing: (1) Notice that they want their personal doctor to treat them you for a work-related injury or illness and (2) provided the personal doctor’s name and business address.

If the MPN enrollment process is not handled correctly, Applicant Attorneys will try to gain control of medical treatment outside of the MPN which can significantly increase the cost of the claim.  If the enrollment process is handled correctly, any treatment outside of the MPN is considered “unauthorized” and the employer/carrier are not responsible for payment.

If you handle this correctly you have gone a long way to curbing your costs and retaining medical control of your Workers’ Compensation claims.  This is just one of the many tools we implement to help our clients reduce work comp costs.

Would like to give credit to HRTHATWORKS.COM, Don Phin, and Bill Litjen for presenting this material in an understandable way in a recent newsletter.

Guy Teafatiller

guyt@vanbeurden.com

Vice President | Kingsburg