On Playing Chicken With § 4616
In April of 2011, the Workers’ Compensation Appeals Board issued a firm rebuke to applicants’ attorneys and lien claimants all over the state: “where unauthorized treatment is obtained outside a validly established and properly noticed MPN, reports from the non-MPN doctors are inadmissible, and therefore may not be relied upon, and … defendant is not liable for the cost of the non-MPN reports.” (Valdez v. Warehouse Demo Services).
The advantages of setting up a Medical Provider Network are many, some of which are discussed here. In particular, under Labor Code § 4616 insurers and self-insured employers can set up networks of medical providers, and all treatment must be received from one of the providers in the network.
In Valdez, applicant was provided treatment within the insurer’s MPN for an admitted injury. After a month of such treatment, applicant began receiving treatment from a doctor outside of the insurer’s MPN at the behest of her attorney. Apparently this was because the MPN doctor’s treatments were not helping her, yet she never contacted the insurer to find a different doctor within the MPN.
The WCJ awarded additional temporary disability, relying on the report of the non-MPN doctor. The WCJ further allowed a lien from the Employment Development Department for the TD period.
In response to defendant’s petition for reconsideration, the WCAB held that the law was the law, and absent a situation in which defendant refuses to provide medical treatment “that is reasonably required to cure or relieve the injured worker from the effects of his or her injury”, the MPN stands.
But then the WCAB blinked, and now we have the NEW Valdez opinion. On July 14, the WCAB issued a new en banc opinion, calling for more time to study the issues of the Valdez case. Hopefully the new opinion will not “fix” what isn’t broken.
As soon as your humble blogger knows more, so shall you. In the meantime, I would hope for the best.