By The California Applicants’ Attorneys Association | Oct 30, 2023

Last week the DWC convened a virtual stakeholders’ meeting to discuss problems with Medical Provider Networks (“MPNs”) in California’s Workers Compensation system.

Doctors, claims administrators, employer representatives, managed care networks, a workers’ compensation judge, and the California Applicants’ Attorneys Association, among others were there.

Here are some scary truths about MPNs.

  • Obtaining authorization to see a treater in the MPN can be delayed by months, when written authorization is required even though the network of doctors is “managed” and chosen by the employer.
  • A workers comp judge who spoke at the meeting reported that over 40% of the cases set on his calendar are on “failure to authorize” even though the injury is not disputed.
  • Determining the correct MPN from which an injured worker can receive treatment can be impossible. Often an injured worker receives a voluminous amount of correspondence from the carriers without any indication of which MPN is applicable.
  • There is no easily accessible database of carriers and their corresponding MPN links available on the DWC website.
  • Many MPN lists contain doctors who are deceased, or do not currently treat/have never treated workers compensation patients, or are unavailable for a myriad of reasons. Auditing requirements are not enforced to clean up these non-functioning MPN lists.

And there’s more, but what you need to know is that these treatment delays and MPN mistakes are extremely costly and detrimental to an already broken workers compensation system.

Thank you to CAAA Past President Christel Schoenfelder and CAAA Regulations Committee members, Kimberley Pryor and Andrew Lockard, for their feedback in lifting the veil on what haunts us with the current MPN system.

CAAA is looking for fixes. There is nothing spooky about that.