2/19/2023 0 Comments Medica in inetwork providersHis doctor initially said Nicolas was temporarily disabled for six weeks. Other than a doctor who sees an injured worker for an evaluation only, called a med-legal examination, the treating doctor determines the dollar value of a case.Įxample: Nicholas injured his cervical spine nine months ago. The treating doctor will also issue an opinion on when the injured worker’s condition has stabilized and the amount of permanent disability he or she has suffered. The doctor will determine the injured worker’s ability to work during the injury and the periods of temporary disability he or she should receive. The treating doctor directs an injured worker’s medical care. The duties of a treating doctor in the MPN include determining: The treating doctor’s opinion about the injured worker’s injury is one of the most important parts of the workers’ compensation process. If the employer has an issue with treatment recommended by the treating physician, the only option is to go through the Utilization Review process. The MPN deals with who is going to treat an injured worker, while UR deals with what treatment the injured worker can receive. The MPN and Utilization Review work together to direct an injured worker’s medical treatment. 7 Medical treatment requests are sent to an independent physician that can approve, modify, or deny the treatment request. MPN doctor and treatment guidelinesĪll treatment in workers’ compensation is based on medical treatment guidelines that determine “the frequency, duration, intensity, and appropriateness of all treatment procedures and modalities commonly performed in workers compensation cases.” 6 This is for the purpose of ensuring that injured workers receive a standardized level of care.Īll MPN doctors must follow the medical treatment guidelines through a process is called Utilization Review (UR). The insurance company must accept Andrea’s selection because the doctor is in the MPN. Andrea cancels her clinic visit and calls to schedules her first visit with her new treating doctor. She goes online and finds a different doctor to be her treating physician. Andrea is not very happy with the treatment she receives at the industrial clinic.īefore she goes back to the industrial clinic, Andrea receives a letter from the insurance company that has the web address of the employer’s MPN. She is sent to an urgent care clinic by her employer. The Department of Workers’ Compensation provides a list of current MPNs that are active in the state.Įxample: Andrea injures her back at work. 5 The online list gives injured workers the ability to schedule appointments without waiting for the insurance company to provide the information, which could cause significant delays. 4Įach MPN is required to have a list of doctors available online. chiropractic practitioners licensed by California state law. physicians and surgeons holding an M.D.The network must have enough doctors to treat common work injuries in all geographic areas of California where an injured worker may live. 2Įach employer can establish their own MPN, but the network must give injured workers access to medical treatment. If an insurer or employer establishes a Medical Provider Network (MPN), an injured worker must be treated by a doctor within the network. 1 However, an injured worker cannot be treated by just any doctor. Medical treatment is a required benefit for injured workers in California workers’ compensation. Medical Provider Networks are a group of doctors approved by a workers’ compensation insurance company to provide treatment to injured employees. Treating with doctors removed from the MPN In this article, our California personal injury attorneys will explain: If any doctor disagrees with the opinion of the current treating physician, the injured worker can change treating doctors. If the injured worker disagrees with the third opinion, he or she can request an Independent Medical Review. If the injured worker disagrees with the second opinion doctor, he or she can request a third opinion. If an injured worker is not satisfied with the treatment program of the treating physician, he or she can request a second opinion from another doctor. the appropriate MPN doctor is not available within a reasonable distance from the injured workerĪfter the first medical visit following an injury, the injured worker can select any doctor within the medical provider network.the employer or insurance company does not provide the injured worker MPN information.Injured workers will generally have to be treated by a doctor within the workers’ compensation medical provider network. Medical Provider Networks (MPNs) are a group of doctors approved by a workers’ compensation insurance company to provide treatment to injured employees.
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