A medical provider network (MPN) is a group of healthcare professionals who evaluate workers’ compensation claims. Their care is covered under the liable insurance provider. The role that the MPN plays in your compensation claim varies, and it will depend on your employers’ insurance, as well as your injuries.
If you would like to be evaluated by an out-of-network doctor, you can partner with a lawyer. They can work with the liable insurer so you could work with an agreed medical evaluator (AME), who you may already have a relationship with.
What Is an MPN?
As noted, according to the California Department of Industrial Relations (DIR), an MPN comprises healthcare providers who evaluate workers’ compensation cases. The network could include dentists, chiropractors, physicians, osteopaths, and other professionals.
Here are some things to know about these professionals:
- MPNs are required to meet current care standards.
- MPNs must follow all medical treatment guidelines as set forth by the DIR.
- MPNs must allow for second and third opinions.
- MPNs must allow for an MPN independent medical review.
What Does an MPN Do?
After you suffer an on-the-job injury, you can choose to partner with a doctor in the approved MPN. If you don’t agree with the treatment the healthcare provider suggests, you have the right to seek a second and even third opinion. Per the DIR, a provider from the approved MPN determines:
- The severity of your condition
- Whether repetitive stress resulted in your condition
- Whether you now have a long-term disability
- Whether you can continue working (or work on light duty)
- When your condition is likely to improve
When you suffer an suffered an on-the-job injury,, your employer must give you the contact information of the overseeing MPN. It must have at least three healthcare providers within a reasonable distance of your home or work.
Frequently Asked Questions About MPNs in Workers’ Compensation Cases
If you’re interested in filing a workers’ compensation claim, you may have some questions, such as:
What Is an Independent Medical Review?
An independent medical review is performed by a different physician than the one who administered the first, second, or third opinion. These reviews are designed to help settle any disputes between the employee and the employer’s insurance company.
These reviews will be paid for by your employer, as they are required by law to offer this coverage.
Can I Choose an Out-of-Network Provider?
After a workplace injury takes place, you can no longer use a provider outside of your employer’s MPN. However, if you meet certain requirements, you may qualify for an exception. Some exceptions include:
- You predesignate a physician any time before an injury occurs.
- You were injured prior to the effective date of the MPN, and your care had not been transferred into the MPN.
- You are exempt from the MPN for other case-specific reasons.
If you do not meet one of these exceptions, then you must use a physician within the MPN. If you feel that this will put you at a disadvantage in seeking benefits, then you should consider speaking with a workers’ compensation lawyer Los Angeles . They can guide you through the claims process and explain the best decisions for your situation.
Why Would I Want a Doctor Outside the MPN?
Choosing a doctor outside of your MPN gives you more control over the physician who treats you and your injuries. By predesignating a doctor, you ensure that you receive care from someone you already know and trust.
If you do not predesignate a provider, then the physician who evaluates you after your injury will be chosen for you. While all of these physicians are pre-approved to be part of the MPN, it is highly unlikely that they will have provided you with health care in the past.
Therefore, their decisions will be based strictly on what they see in your past medical records, as well as the symptoms you are showing following your injury. It will be your responsibility to inform them of any prior injuries or illnesses that could have worsened or contributed to your work injury.
What if My Employer Does Not Have an MPN?
If your employer does not have an MPN, then it’s violating state and federal law. However, this allows you to choose a healthcare provider that you’re already familiar with. Still, this doesn’t make matters easy; if your employer doesn’t have an MPN, then you might not have access to other forms of coverage offered to people in your position. You can partner with a workers’ compensation lawyer who can work to assure you get the benefits you need.
What if My Employer Has an MPN, But I Want to See an Uncovered Physician?
If you disregard your employer’s MPN and see a doctor outside of the approved network:
- You may have to pay for any treatment costs out of pocket.
- The insurer may not consider your doctor’s opinion.
You shouldn’t feel “trapped” by having to partner with a doctor in your employer’s MPN. You have the right to vet potential doctors and choose one that meets your circumstances. Of course, if you have problems doing this, you can consult a lawyer who focuses on workers’ compensation cases.
Contact KJT Law Group Today to Learn More
If you suffer an injury at work, you may be concerned about your next steps. By working with an attorney, you can be better informed of what legal terms, such as MPN, mean and how they impact your claim.
At KJT Law Group, we are committed to helping each of our clients receive the workers’ compensation benefits that they deserve. We will work with you from start to finish to make sure that you understand your rights, decisions, and options.