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August 19, 2011 In Workers Compensation By Rene Sanchez

The Importance of Your Workers Compensation MPN Network is Validated!

This past Spring, an important “en banc” decision was made by the California WCAB.  Praise the WCAB for reviewing and rescinding a Work Comp judge’s decision on the case of Elayne Valdez, Applicant vs. Warehouse Demo Services.

* 76 Cal. Comp. Cases 330   WCAB No. ADJ7048296

This “en banc” decision has given all of California’s employers a real break for being compliant with Work Comp laws. As most employers, brokers, adjusters, etc., already know, it is not uncommon for injured workers to (with direction from their attorneys) seek treatment with a physician outside of the established MPN network, which will in turn, almost always, change the entire course of the claim and muck up the claims process. They change the disability status, diagnosis, add injured/affected body parts, and treatment plans. Thus, what typically happens is the non-network physician will create and file thousands of dollars worth of (mostly) medical liens that pile up against the claim. Defendants/employers are almost always held liable for the liens. Does this sound familiar? For the employers that have Ex-mods, the liens alone add damaging points to their Ex-mod, which in turn cause a direct increase to their insurance premiums. The extended claim duration and litigation will (almost always) add even more costly points to the Ex-mod.

Why should an employer, broker, adjuster, etc., care about the “en banc” decision? The WCAB panel addressed medical treatment, medical provider networks, treatment outside of the networks, medical reports and admissibility.

The “en banc” decision expressed and validated the importance of the MPN network. The WCAB held that when an employer has a validly established medical provider network and all the proper MPN notices required by the provider network statutes and regulations are provided to the injured worker/applicant prior to an injury, then if the injured employee seeks unauthorized treatment obtained outside the MPN (when validly established and noticed), those medical reports from non-network physicians are inadmissible. Furthermore, employers are not liable for the cost of non-network physician reports and treatment. However, injured workers/applicants do have the right to provide, at their own expense, treatment with any physician.

Advice to every employer or those who give advice to employers: please make sure that you are posting all the updated MPN notices, and providing your employees with all the correct MPN handbooks and pamphlets before an injury and when the injury occurs. You should document that you have done this in order to provide proof for when you are challenged by the applicant’s attorney and the non-network physicians. If you do not comply with the MPN regulations, you will likely lose control of your claim and the overall cost of the claim.

If you have any questions about this topic please do let me know. I will be more than happy to assist you.

Rene Sanchez