Court rules that Employees must be notified of MPNS (9/6/2007)

An employer or insurer that fails to notify employees of their rights under a Medical Provider Network (MPN) will be liable for costs of medical treatment employees secure on their own outside the MPN, according to a recent decision of the full Workers’ Compensation Appeals Board. The required MPN information informs employees about their rights in an MPN and how to receive appropriate medical treatment from an MPN in a timely manner.

Last year, the Workers’ Compensation Appeals Board in the case of Knight v. United Parcel Service, ruled that an employer must prove that it provided the required Notice of Employee Rights to Medical Care in a Medical Provider Network (MPN) at the time the injury is reported to avoid losing control of the medical treatment and paying for “self-procured treatment” by the applicant. This notification is required by Labor Code Section 4616.3 and California Code of Regulations, Title 8, Section 9767.12(a).

Under California workers’ compensation laws, employers with an MPN have an affirmative duty to, among other things, offer treatment to workers and instruct employees at the time of hire and when an injury occurs as to how to choose a doctor within the MPN. Because these steps are crucial to reasonable medical treatment, the Workers’ Compensation Appears Board found that a failure to take these steps permits employees to be treated by their own physician and requires the employer or insurer to pay all associated costs.

You can rest assured that the applicant attorneys and non-approved medical providers will be using this decision to break the MPN system under the new workers’ compensation reform law.

Merely handing the workers’ compensation brochure to the employee may not stand up in Court. It is suggested that as soon as possible, employers secure a signed acknowledgement from the employee that notification of the MPN has been given to the employee at the time the injury is reported. A copy of the executed document should be kept in the claim file and the employee file.

It should be noted that the above requirements are in addition to the following requirements at the time of hire: the employee should be provided with the workers’ compensation brochure outlining the worker’s rights under the workers’ compensation laws; a form to pre-designate a doctor; and lastly, the list of doctors in the MPN.

Failure to provide a list of the MPN providers at the time the injury is reported may result in the employee obtaining self-procured treatment which the employer will be liable for. Additionally, once the employee obtains self-procured treatment, the employer loses control that it would otherwise maintain from doctors within the MPN.

WHAT IT MEANS FOR EMPLOYERS:

Employers should implement a “fail-safe” system to make sure that every employee who makes a claim is notified, that you can prove this in writing, and that the employee was given the proper notification forms. Supervisors must be trained to provide the forms to employees who report that they are injured, and to obtain the employee’s signature on a form acknowledging the notification.

The goal of this article is to provide employers with current labor and employment law information. The contents should neither be interpreted as, nor construed as legal advice or opinion. The reader should consult with Saqui & Raimondo at (831) 443-7100 in Salinas, (916) 782-8555 in Sacramento, or at (559) 449-8585 in Fresno, for individual responses to questions or concerns regarding any given situation.

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