In the California Workers Compensation System an injured worker’s right to medical treatment does not guarantee treatment for an injured worker. For example, an injured worker can have authorization to see a specialist for a consultation, but never see a specialist for many reasons. Many firms, attorneys, and paralegals have spent hours trying to find a specialists to treat their clients.
However, Labor Code Section 4616 puts the responsibility of finding a physician to the Medical Provider Network. In part Labor Code section 4616 states: “every medical provider network shall provide one or more persons within the United States to serve as medical access assistants to help an injured employee find an available physician of the employee s choice, and subsequent physicians if necessary, under Section 4616.3.”
8 CCR 9767.5(g) clarifies the responsibilities of the Medical Provider Network with the following language: “MPN applicant shall ensure that an initial appointment with a specialist in an appropriate referred specialty is available within 20 business days of a covered employee's reasonable requests for an appointment through an MPN medical access assistant. If an MPN medical access assistant is unable to schedule a timely medical appointment with an appropriate specialist within ten business days of an employee's request, the employer shall permit the employee to obtain necessary treatment with an appropriate specialist outside of the MPN.”
Essentially, once the injured worker has authorization and communicates to the MPN Medical Access assistant that an appointment is needed, the MPN Medical access assistant has a duty to ensure an initial appointment with a specialist within 20 days.
Diclaimer: The above blog does not constitute legal advice. This blog is provided for general informational purposes only and should not be relied upon as current and comprehensive legal advice. Nothing herein provided will form the basis of an attorney-client relationship, nor will it constitute attorney advertising.
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Joseph Lounsbury, Esq., practices Workers' Compensation in Santa Maria, California.