What is a Medical Provider Network and How Can I Get Treatment for my Work Injury?

The Law Offices of Marc Francis, Santa Rosa workers comp lawyer, can help you navigate the Medical Provider Network (or “MPN”) system and get the treatment you need for your work injury.

Current California workers compensation law allows employers and their workers compensation insurance carriers to maintain a list, or Medical Provider Network, of medical providers such as doctors, hospitals, physical therapists, chiropractors, and other specialists, and require their injured employees to select from the MPN. But if the MPN does not meet California law standards for availability of treatment it may be possible to receive your work injury treatment outside of the MPN.

Perhaps you have attempted to find the correct doctor on the employer’s Medical Provider Network but the specialist you need is not listed. This is a common problem with some of these networks. In some of these cases the employer and their workers compensation insurance carrier can be ordered to provide treatment with a doctor not on their approved list. An example is in a serious injury case requiring a specific type of treatment, such as a complicated or specialized surgery not performed by the doctors available on the MPN.

Some injured workers live and work in remote locations where there simply are not enough doctors of the type the worker needs to allow a reasonable choice of treating physician, as required by California law. In such cases it may be necessary to take the case to a hearing before a Workers Compensation Judge and get an order for the treatment needed with a local doctor, even if the doctor is not listed on the employer’s Medical Provider Network. In such a case treatment can sometimes be ordered with a doctor closer to your home. If the correct doctor is not available locally and travel is necessary, the employer and their insurance carrier may be ordered to pay your travel costs.

Injured workers sometimes report that the “doc-in-a-box” clinic they were sent to after their work injury seems to be working for the insurance company and not in the injured worker’s best interest. We hear descriptions of injured workers attempting to explain where they feel pain from their injury and coming away feeling as though they were not listened to by the clinic personnel, who may not even have been a doctor, but only a medical assistant of some kind. The injured workers often have to wait for hours to be seen, then the clinic completes a few forms and sends them on their way without taking a complete history of the injury or doing a complete examination of all the parts of body causing pain or discomfort. Often these clinic forms fail to list all injured body parts or to provide for the correct workers compensation benefits, resulting in denials and delays.

These problems with Medical Provider Networks can delay receipt of benefits and lengthen the time it takes to recover and return to work. But the Law Offices of Marc Francis, Santa Rosa workers comp lawyer, can help. We can review the facts and circumstances of your particular case and provide assistance to get you on the road to recovery. Call today for an appointment.