MEDICAL PROVIDER CONTROL:

I questioned the patient about whether or not his employer had pre-notified him that he had been inducted into an employer controlled Medical Provider Network (“MPN”). The patient stated that he was never given any such notification either before or after the injury as mandated by Title 8 section 9767, which states, in relevant part:

"An employer or insurer that offers a Medical Provider Network Plan under this article shall notify each covered employee in writing about the use of the Medical Provider Network 30 days prior to the implementation of an approved MPN, at the time of hire, or when an existing employee transfers into the MPN, whichever is appropriate to ensure that the employee has received the initial notification. The notification shall also be sent to a covered employee at the time of injury. The notification(s) shall be written in English and Spanish.”

Therefore, the employer (if they did have an MPN – this issue was never raised) has lost medical control and the patient may treat outside of any MPN. This contention was also supported in a recent WCAB panel decision – Metoyer vs. Wilshire Dental; Zenith (2005) 34 CWCR 14.

In Metoyer, the WCAB commissioners upheld the WCJ’s decision to award medical care provided by a medical facility that was NOT within the insurer’s MPN because of failure to comply with Labor Code § 3550. The commissioners further opined that a violation of Title 8 CCR 9767.12 would also constitute loss of control. More explicitly, the commissioner’s stated, in relevant part:

"Additionally we note that AD rule 9767.12 provides for required notices to be given prior to an injury, specifically written notice of a medical provider network under Labor Code section 4616.3 prior to the implementation of an approved MPN, at the time of higher, or when an existing employee transfers into the MPN. While specific consequences for a failure to provide required notice are not described in AD Rule 9767.12, when coupled with the aforementioned Labor Code section [section 3550(e)], the consequences herein may be justified."

Again, we would have a strong argument that this patient was free to procure medical treatment outside of any employer MPN.