What is a Medical Provider Network (MPN)?

Medical Provider Network (MPN) in San Diego, California.

Selecting a healthcare provider is deeply personal. It’s common to visit a few different doctors until you find one that listens to your concerns and makes you feel at ease. This is the individual you will trust with preventative care, diagnosis and treatment, and finding specialists when you need them. Unfortunately, when you suffer a job-related illness or injury and file for workers’ compensation, you don’t get to choose your own doctor for treatment. California workers are required to see a physician in their employer’s medical provider network.

What is a medical provider network?

A medical provider network (MPN) is a group of doctors created to treat injured workers. In California, employers can create their own networks of physicians and require their employees to be treated by one of these doctors for any work-related medical conditions. The California Division of Workers’ Compensation must approve a medical provider network before it can be used.

Am I required to see a doctor in my employer’s medical provider network?

Some states allow an injured worker to seek treatment for a work-related injury from his or her own physician. In California, however, you must initially see a doctor chosen by your employer if he or she has an approved medical provider network.

Are there any exceptions?

Any California employee that files a workers’ compensation claim must be treated by a doctor within his or her employer’s medical provider network unless:

  • The employee properly pre-designates a physician before an injury or illness occurs, even if the physician is in the medical provider network.
  • The employee becomes injured or ill prior to the effective date of the medical provider network and his or her care has not been transferred to the MPN.
  • The workers’ compensation insurance carrier or the employer otherwise exempts the employee from the medical provider network.

If an employee requires immediate care following an injury, emergency room visits are covered by workers’ compensation.

What if I don’t like my doctor?

If you’re unhappy with the first doctor your employer selects for you, you may request a second and third opinion within the medical provider network. If you’re still dissatisfied after receiving a second and third opinion, you can request an independent medical review (IMR) with a doctor outside the network. If you do choose a new physician, make sure he or she is authorized to treat you and completes any necessary forms documenting the change to ensure your workers’ compensation claim proceeds smoothly.

Do you disagree with your work-related medical diagnosis?

Suffering an injury or illness as a result of your job is troubling enough. Seeing a doctor you’ve never met and who doesn’t understand the “big picture” of your health can make a difficult situation even more uncomfortable – especially if you disagree with your diagnosis.

If you believe you’ve been misdiagnosed or improperly treated by a physician in your employer’s medical provider network, please contact us. At the Law Office of Gerald Brody & Associates, we know how frustrating it can be to not feel in control of your own health. Allow us to handle the legal side of your case so you can focus on what’s most important – your recovery.

Call us today to schedule your free consultation at (619) 528-9800.