Medical Provider Network (MPN)

A Medical Provider Network is a group of health care providers approved to treat injured workers by the California Department of Workers’ Compensation. Medical Provider Networks include doctors specializing in general areas of medical care as well as those specializing in work-related injuries. A Sacramento workers’ compensation attorney can help you understand what the Medical Provider Network’s access standards are, exceptions to being a part of a Medical Provider Network, and what to do if your Medical Provider Network is in violation of the California Code of Regulations. For more information on Medical Provider Networks, contact the Sacramento Workers’ Compensation Attorneys, P.C. now so we can help you understand how it will affect your work-related injury.

What are the Medical Provider Network access standards?

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 with a 30-minute drive or 15 miles of every covered employee's residence or workplace. Additionally, the Medical Provider Network must have physicians who specialize in work-related injuries within a 60-minute drive or 30 miles of every covered employee's residence or workplace. 

Are there exceptions to being a part of a Medical Provider Network?

Companies are not required to be a part of a medical provider network; however, if they do, then 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

Certain conditions must be met to pre-designate your personal physician to treat a work-related injury. These include: 

  • Your doctor agrees to be your pre-designated physician in the event of a work-related injury. 
  • Pre-designation form must be filed that includes the physician's name and address, pre-designating your personal doctor before the injury. 
  • You have current healthcare that covers non-occupational illnesses or injuries.
What do I do if I believe the Medical Provider Network violates the California Code of Regulations?

If you believe your Medical Provider Network violates requirements, you may 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. If the alleged violation is not corrected within those 30 days and the Medical Provider Network has submitted their dispute, the complainant can file a written complaint with the Division of Workers' Compensation. The Division of Workers' Compensation has its own complaint form that must be filled out and submitted to them. If the violation is more severe and resulted in an immediate threat to the worker's life, the complainant can file a complaint with the Medical Provider Network and the Division of Workers' Compensation at the same time.

What can Sacramento Workers’ Compensation Attorneys, P.C. do? 

Understanding Medical Provider Networks can be confusing when you are trying to get medical treatment for your workers’ compensation case. To learn more about your rights, please call Sacramento Workers’ Compensation Attorneys, P.C. We can help you understand the Medical Provider Network’s access standards, exceptions to being a part of a Medical Provider Network, and what to do if your Medical Provider Network violates the California Code of Regulations. Our Sacramento workers’ compensation lawyers are here to help you get the most for your workers’ compensation case.