Medical treatment and the MPN

LABOR CODE § 4600

“Medical, surgical, chiropractic, acupuncture, licensed clinical social worker, and hospital treatment, including nursing, medicines, medical and surgical supplies, crutches, and apparatuses, including orthotic and prosthetic devices and services” — whatever is reasonably required to cure or relieve you from the effects of the injury.

An MPN is a list of physicians the employer or insurer has assembled. If your employer has one, your treatment generally has to come from inside it. The access standards are real and enforceable: a primary treating physicianPTP Primary Treating Physician. The doctor directing your care. within 30 minutes or 15 miles of your residence or workplace, an occupational health specialist and hospital within the same standard, and specialists within 60 minutes or 30 miles. The notice requirements are also real — written notice of the MPN, how to find and change physicians, and how to dispute a treatment decision, including at the time of injury.

Changing doctors inside the network

1. Change to any other physician in the network, at any time, without permission.
2. Get a second opinion from a network physician if you disagree with your treating physician’s diagnosis or treatment plan.
3. Get a third opinion if you still disagree.
4. Request MPN Independent Medical Review if the third opinion does not resolve it.

You do not need anyone’s approval to switch to a different doctor within the network — and if the relationship with your treating physician has broken down, that is often the fastest fix available.

The law gives you the right to treat with your own physician from the date of injury if you notified your employer in writing before the injury and you have non-occupational health coverage. Five requirements, all of which must be satisfied before you are hurt:

An old rule to set aside: predesignation once required that your employer offer group health insurance. The current statute requires only that you have non-occupational health coverage on the date of injury — from any qualifying source, including a spouse’s plan or a policy you bought yourself.

Predesignation beats the MPN, because the right operates “from the date of injury” — there is no employer control window at all. The employer does retain utilization reviewUR Utilization Review. The process that approves, modifies, or denies each treatment request. A modification is a denial of what it left out. rights over what your doctor requests. There is no cure for missing this. File it before the injury or the right is gone. If you have a doctor you trust and a job with any physical risk, this is worth twenty minutes this week. A separate and weaker right exists for predesignating a personal chiropractor or acupuncturist, but it works only where the employer has no MPN.

Then the older rules apply, and they are more generous. One free change of physician on request — the claims administratorClaims administrator / adjuster The person handling your claim for the insurer or self-insured employer. must provide an alternative physician no later than 5 working days from receiving your request. And after 30 days from the date the injury is reported, you may treat with a physician of your own choice within a reasonable geographic area; on notice, the claims administrator has 20 days to authorize.

Note the trigger: 30 days from when the injury is reported, not from the date of injury. “You can choose your own doctor after 30 days” holds only where there is no MPN — and almost the entire insured market operates one.

You have one primary treating physician at a time. That doctor is responsible for your overall care, for writing the reports that drive your case, and for requesting authorization for treatment. The Doctor’s First Report, the periodic PR-2 reports, and the permanent and stationaryP&S / MMI Permanent and Stationary / Maximum Medical Improvement. Your condition has plateaued — not that you are healed. Temporary disability ends here. report are the documentary spine of your claim — they determine your work status, your restrictions, and ultimately your impairment. A treating physician who does not write, or writes thinly, damages your case even if the medical care is fine. That is a legitimate reason to change doctors.

For injuries on or after January 1, 2004, you are generally limited to 24 chiropractic visits, 24 physical therapy visits, and 24 occupational therapy visits per industrial injury. The employer may authorize more in writing, and post-surgical physical medicine is treated separately. After 24 chiropractic visits, a chiropractor generally cannot continue as your primary treating physician without written authorization.

What to do now

• Ask, in writing, whether there is an MPN — Keep the response. A failure to give proper notice can matter later.
• If you are still working and uninjured, file the predesignation this week — DWC Form 9783, signed by your doctor, delivered with proof.
• If you dislike your doctor, switch inside the network — Any network physician, any time, no permission needed.
• Start the mileage log — Every visit, every mile, parking and tolls.