Well Beyond Work: Medical Provider Networks
By Diana Rodriguez-Garcia | Published September 14, 2022
The most frequently asked question when an injury occurs at work is “Can I see my own doctor?”
The answer depends on the state in which the injury occurs.
In California the medical provider network (MPN) is established by the workers compensation insurance carrier or self-insured employer and approved by the Division of Workers’ Compensation’s (DWC) Administrative Director to treat injured workers on the job. This directory is available online and accessible to both employer and employee. You can download a list of approved MPN’s in California.
The advantages of an MPN include:
Lifetime medical control
Medical cost savings
Quality physicians
Appropriate medical treatment
What is an MPN Notice?
To implement the MPN an employer must provide an MPN notification letter to the employee at the time the injury is reported. In addition to providing the MPN Notification, employers should also:
Post State form “DWC-7 Notice to Employees – Injuries Caused by Work”
Include the “Your Workers Compensation Benefits New Hire Notice (English and Spanish)” notice in all new hire packets
At time of injury provide the state form “DWC-1 Employee Claim Form & Notice of Potential Eligibility” to employees
An injured employee may be allowed to treat outside of the MPN if they predesignate a physician. The employee must have the predestination request on file before an injury occurs.
Each state has their own regulations and rules regarding the selection of a physician. For example, in Texas, Travelers insurance offers a customized Health Care Network (HCN) that is certified by the Texas Department of Insurance and is made up of credentialed medical providers who deliver initial and specialty care for the treatment of work-related injuries.
Employers can do many things to make a visit to the industrial clinic more efficient and pleasant for their injured employees.
Visit the Industrial Clinic and meet with the staff
Provide the clinic with your current Workers Compensation Carrier Information
Provide detailed job descriptions
Establish Return to Modified Work Protocols
Determine if they offer other services such as Fit for Duty or Drug screening
How to Choose a Doctor Within the MPN
After an injured worker files a claim for workers’ compensation benefits, they will need to use the MPN.
When the injured employee notifies an employer about an injury, the employer should assist in the setup of the initial medical appointment with an MPN doctor and provide guidance throughout their treatment. Therefore, in reviewing the medical provider network, it is important to verify that there are specialists available to address the employee’s needs – as after the first visit, the employer is required to provide the injured worker their MPN list (along with information about each doctor) because they have the right to choose a different treating physician.
Accessibility of the MPN
An MPN must have providers and specialists who can treat common injuries experienced by the injured employees within 60 minutes or 30 miles of a covered employee's residence or workplace.
An injured worker may seek treatment with a specialist outside of the MPN if the facilities are not within a geographical distance or lack the specialty needed to treat the injury.
Why Do We Have MPNs?
Medical treatment is a required benefit for injured workers in California workers’ compensation. However, an injured worker cannot be treated by just any doctor. If an insurer or employer establishes an MPN, an injured worker must be treated by a doctor within the network.
Each employer can customize their own MPN to fit their needs, but the network must give injured workers access to medical treatment. The network must have enough doctors to treat common work injuries in all geographic areas where an injured worker may live.
MPN’s benefit employers, employees, and insurance carriers. Employers maintain control of the medical care; injured employees obtain the medical care needed and insurance carriers mitigate costs. A tremendous amount of effort is put in place to create an MPN and select physicians familiar with industrial injuries and handling of authorizations for treatment.
For further assistance with MPN’s be sure to contact your insurance carrier or broker.
Diana Rodriguez-Garcia
Senior Workers Compensation Claims Consultant
As Newfront's Senior Workers Compensation Claims Consultant and Health Advocate, Diana provides consultation in workers compensation laws, rules, and regulation to employers. Through Newfronts' Circle of Care multifaceted approach, she assists employers in managing workplace injuries, prioritizing employee health and well-being, and controlling costs.
