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WCAB Holds MPN RFAs Can Be Subject to UR

Hello, dear readers!  The weekend has drawn to a close, the sun has risen on a Monday, and so begins the dance of workers’ compensation, once again, for all of us to endure and some of us to survive.

That being said, your humble blogger will remind you that this humble little blog did its part in raising the hue and cry of the theory, oh-so-appealing, to applicants’ attorneys everywhere: a defendant can use the MPN or Utilization Review, but not both.

In the case of Stock v. Camarillo State Hospital, applicant sought reconsideration of the WCJ’s determination that defendant’s UR was admissible.  Why would the applicant think the UR report was inadmissible?  As the WCAB summarized applicant’s argument, “[a]pplicant contended that the UR report was not admissible based upon her assertion that the employer may not contest through UR a request for authorization by a treating physician within the employer’s [MPN].”

While treating applicant’s petition as a petition for removal, the WCAB held that “applicant’s required participation in her employer’s MPN dos not prohibit defendant from referring an MPN physician’s request for authorization of medical treatment to UR and [IMR].”  The WCAB further noted that, as the California Supreme Court held in Sandhagen that UR is mandatory for all requests for treatment.  Applicant’s theory would, effectively, let an employer “opt-out” of UR, by choosing the set up an MPN instead.

Now, if you present this to an applicant’s attorney, you will likely get the response “this is just a panel decision.”  Hogwash – this is an indication of how the commissioners will rule on this issue – 3 of 5 sitting commissioners, in fact.

So, dear readers, go on – UR that MPN Doc’s RFAs without fear!

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  1. Tom
    October 7th, 2014 at 20:13 | #1

    Considering there are plenty of mpns that are “off the shelf” (I.e. loaded with ahem….winners and are built for coverage not quality) this idea that a doctor should be unquestioned has always been maddening.

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