Medical Provider Network (MPN)

Medical Provider Networks follow specific access standards. According to the California Code of Regulations, Title 8 Section 9767.5, a Medical Provider Network must have at least three primary treating physicians and a hospital within a 30-minute drive or 15 miles of every covered employee’s residence or workplace. Additionally, the Medical Provider Network must have physicians specializing in work-related injuries within a 60-minute drive or 30 miles of every covered employee’s home or workplace. 

Companies are not required to be a part of a medical provider network; however, if they do, all employees must receive treatment through the medical provider network. There are a few exceptions:

• The employee pre-designated a doctor before the injury occurred
• The employee’s injury occurred before their employer entered into the medical provider network
• The employee was previously exempt from the medical provider network by their employer or the medical provider network insurance.

To pre-designate your physician to treat a work-related injury, certain conditions must be met. These include: 

• Your doctor agrees to be your pre-designated physician in the event of a work-related injury. 
• A Pre-designation form must be filed, including the physician’s name and address, pre-designating your doctor before the injury. 
• You have current healthcare that covers non-occupational illnesses or injuries.

If you think your Medical Provider Network meets requirements, you can submit a written complaint directly with the Medical Provider Network contact. The written complaint must detail the alleged violations and include the following information.

• When the alleged violation occurred
• If the suspected violation is still occurring
• What, if anything, the Medical Provider Network has done to remedy the violation?
• If the violation has had any impact on the injured worker

The Medical Provider Network has 30 days to respond to the complaint from the date the complaint was received. Within those 30 days, the Medical Provider Network must respond by taking responsibility and fixing the violations or disputing the claim in writing. Suppose the alleged violation needs to be corrected within those 30 days, and the Medical Provider Network has submitted its dispute. In that case, the complainant can file a written complaint with the Division of Workers’ Compensation. The Division of Workers’ Compensation has a complaint form that must be filled out and submitted. Suppose the violation is more severe, resulting in an immediate worker’s life. In that case, a threat to the complainant can file a complaint with the Medical Provider Network and the Division of Workers’ Compensation simultaneously.