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As part of your workers’ compensation claim comes medical benefits. The workers’ compensation carrier will have implemented the statutory Medical Provider Network (MPN) from which an injured worker can designate a treating physician.
The regulations (8 CCR §9767.5) requires an MPN to have three available physicians of each specialty to treat common injuries experienced by injured employees based on the type of occupation or industry. The question is what if there are not three physicians in a specialty from which you desire treatment for your injury? For example, you want to designate an orthopedist to act as your primary treating physician and the MPN has only one provider.
In Soto v. Sambrailo Packing, the WCAB looked at this regulation and Labor Code 4616(a)(1) and determined that an MPN is required to have an “adequate” number and type of physicians to provide treatment, and if the MPN provides access to an appropriate selection of specialists or physicians with appropriate expertise to provide medical treatment, the access standards are satisfied.
This means that although the MPN may have only one orthopedist, if there is an appropriate selection of physicians in occupational medicine, general practice, family practice, internal medicine or physical medicine and rehabilitation, an injured worker must designate a provider from within the MPN. The latter specialties treat common industrial related injuries. If a referral to a specialist is necessary, your treating physician can request a referral to the MPN specialist, and if they are not available, then to a non-MPN specialist.
If your employer’s MPN has the appropriate selection of physicians to treat common industrial related injuries, you may be required to designate a provider from within the MPN.
If you have any questions about your workers’ compensation injury and want to talk to an attorney in Fresno, please call (559) 408-7436 or fill out the form to the right.