Metoyer v. Wilshire West Dental; Zenith Ins. Co. (2005) LBO 368875

How many times this year have you been told by the insurer that you can’t treat a new patient (work related) because you were not on their Medical Provider Network (“MPN”)? If you have, this decision may help:

In Metoyer a panel of three commissioners upheld a WCJ’s opinion that an injured worker could treat outside an insurer’s MPN because the employer failed to comply with the work-place notification requirements of Labor Code section 3550; furthermore, they opined that if the employer would have violated Title 8 CCR section 9767.12, the injured worker may also be allowed to treat outside an insurer’s MPN. More explicitly, commissioner Rabine wrote:

"Additionally we [the WCAB commissioners] 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 hire, 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."

The bottom line of this WCAB opinion would seem to indicate that if the employer failed to either post the notices required by Labor Code section 3550 or the MPN notification requirement or Title 8 CCR 9767.12, then the injured worker is free to treat with whom every he or she wants.