It has come to your humble blogger’s most humble of attentions, that there is a case floating around the workers’ compensation world, Hogenson v. Volkswagen Credit, Inc. which advances the proposition that a defendant cannot submit an MPN doctor’s Request for Authorization to utilization review.
Now, as much as I would have liked let this go unnoticed, my uncle Boris’ sage advice always comes to mind at times like these: “BORIS SMASH!”
Mr. Hogenson was treating with an MPN physician for an admitted injury sustained in 2000. The PTP had sent in a Request for Authorization (RFA – not to be confused with the RAF, which so bravely defendant England in World War II, as that collection of aces would have been hard for any defendant to resist)
Utilization Review denied the request and applicant, as they all do now, set the matter for hearing.
The WCJ provided a history of the UR and MPN systems, and noted that UR was introduced to help control the cost of medical treatment, and then the MPN system was introduced to offer greater control. In fact, the WCJ noted that “[a] defendant was not able to [assert] total control over the choice of Applicant’s treating physician. A defendant controls what doctors are invited to participate in the MPN and the defendant may then oust the physician from the MPN.”
Citing section 9767.7(g), the WCJ further opined that the employer must allow recommended treatment to be obtained within the MPN.
The WCAB issued an opinion granting reconsideration in June of 2014 to study the issue, and it doesn’t look like there is an answer just yet from the WCAB.
If you have had no experience with the frustration and difficulty inherent in forming a statutorily acceptable MPN, then allow me to sing you the song of my people.
The regulations require an MPN to have at least 3 primary treating physicians within 15 minutes and/or 30 miles of an injured worker’s home or residence. The regulations also provide that the MPN must provide at least 3 specialists within 30 minutes or 60 miles of the same. Applicant’s attorneys, on a regular basis, will argue that the specialty of pain medicine or chiropractic care is NOT a specialty, and so an MPN must have 3 pain management and 3 chiropractors within 15 miles of an applicant’s home or work.
Now, just try to find at least 3 physicians of every specialty, 15 miles from everywhere. Just try to find 3 physicians that are competent, dedicated, don’t overcharge, don’t over prescribe, and also have enough space in their practice to accommodate injured workers that will, as often as not, lie to them about their symptoms or the circumstances of their injuries.
Try finding enough doctors willing to come to work every day and have applicants’ attorneys degrade and insult them for refusing to maim their clients with unnecessary surgery or drive them to a narcotics addiction all to maximize permanent disability.
Now tell me about how easy it is to form a working MPN and how much control the employer really has – forced into the impossible choice of having a porous and defenseless MPN or “stocking the pond” with more ducks than fish (get it? the quacks? ducks?) that you’d rather not have in there.
Utilization review is an absolutely necessary defense for employers to have for those times that the bad doctors get allowed onto the MPN out of desperation.