Taking Control of Work Comp Claims in California

One of the HR That Works Member companies expressed the following frustration with their work comp claims:

….is a current member of HR That Works; we would like to know if they are allowed to have current employees sign a document that states in the event of an injury they will utilize the employer’s MPN of Providers through the Workers’ Compensation carrier.

How do we prevent an injured worker from treating outside of the MPN when they are represented by an attorney? Client has a new claim reported last month, employee was released to return to work on modified duties on 04/29/11; Employee did not agree w/the MPN Provider’s diagnosis. He obtained his own Chiropractor & presented a disability form to the employer today. We suspect he has hired an attorney. How do we prevent these claims from treating outside of the MPN? We are seeing a lot of these claims. The insurance carriers are not being very proactive at encouraging these claimants to go back into the MPN; the attorneys are increasing the number of liens which are being tied up in the Liens Unit.

So, we went to our network and Bill Litjen, one of the most knowledgeable experts on Work Comp procedures in California, provided us with a truly complete answer as follows:

This is one of the most misunderstood advantages an employer has in controlling medical treatment of injured workers.  Most brokers don’t understand it nor know how to explain the consequences to the employer if they don’t properly enroll employees in the prescribed timeframes.

Almost all CA WC carriers offer an MPN (Medical Provider Network) as the way to maintain medical control and cost.  This is a standard product and all policyholders are expected to participate.  The State Division of Workers’ Compensation (DWC) regulates how an MPN is implemented.

Anytime the employer changes WC carriers, they need to re-enroll employees in that carriers MPN (very similar to open enrollment for Employee Group Health benefits).   The carrier should provide enrollment forms:

1) Employee Implementation Notice of MPN

2) Acknowledgement of receipt of MPN Information

3) Initial Written Employee Notification RE: Medical Provider Network – (English version)

4) Initial Written Employee Notification RE: Medical Provider Network – (Spanish version)

To enroll employees:

1) Provide all employees with a copy of the Employee Implementation Notice.  This notice will need to add their Name and MPN Effective date prior distribution to employees.  It may be also be provided via email if the employee has regular electronic access to email at work to receive this notice prior to the implementation of the MPN. If the employee cannot receive this notice electronically at work within the required time frame, then the employer has to ensure this information is provided to the employee in writing prior to the implementation of the MPN.

2) Include copies of the Employee Implementation Notice of MPN in new hire information

3) Have every employee verify receipt of the Employee Implementation Notice of MPN.  Keep these signed acknowledgements on file (more on this).

4) Complete and return the MPN Implementation Verification Form to the insurance carrier (This is for their  tracking purposes only and does NOT replace the employers record of the distribution of the notices)

5) Post the Initial Written Employee Notification RE: Medical Provider Network, both in English and Spanish, in a conspicuous location frequented by employees during the work day hours and in close proximity to the workers compensation posting notice (DWC7 Notice to Employees-Injuries caused by Work). The Initial Written Employee Notification RE: medical Provider Network should also be provided to employees at time of injury.

During the enrollment process, the employee will also be given the opportunity to “pre-designate” their own personal physician to treat a work-related injury. This could be a red-flag!  They can pre-designate their personal doctor of medicine (M.D.) or doctor of osteopathy (D.O.) only if: the employer offers group health coverage; the doctor has treated the employee in the past and medical records; prior to the injury the doctor agreed to treat them for work injuries or illnesses and; prior to the injury they provided the employer the following in writing: (1) Notice that they want their personal doctor to treat them you for a work-related injury or illness and (2) provided the personal doctor’s name and business address.

If the MPN enrollment process is not handled this way, Applicant Attorneys will try to gain control of medical treatment outside of the MPN which can significantly increase the cost of the claim.  If the enrollment process is handled correctly, any treatment outside of the MPN is considered “unauthorized” and the employer/carrier is not responsible for payment.

Now that’s what I call an answer! Thanks again, Bill!

David Shields of Partee Insurance had this to add to the above:

“We thought it wise to advise on a couple of things in this article:

• Resigning all employees into a new MPN IF you change carriers is not always the ‘right thing to do’… especially if you have an on-going claim and treatment with the expiring carrier with a different MPN.
• Resigning a “designated physician” when one changes carriers is not necessary… once is enough and that’s normally at ‘new hire’ time OR when you decide to get all employees to complete the paperwork for their personnel file when the employer understands the ‘designated physician’ notification requirement.”

P.S. More info on the MPN and employer rights can be found at http://www.dir.ca.gov/dwc/Employer.htm.