San Francisco Bay Area Workers' Compensation Law Blog

Frustrated with Medical Provider Networks (MPN) and getting an appointment to see a treating physician or specialist? Try asking the MPN and/or insurance carrier to assign a Medical Access Assistant (MAA) to your case.

The Department of Industrial Relations’ (DIR) website has a list of every approved MPN. That list can be found here:

https://www.dir.ca.gov/dwc/mpn/ListApprovedMPN_Alpha.pdf

The DIR requires each MPN to post a roster of every approved MPN doctor on the MPN’s website. The roster is supposed to be updated quarterly, and must contain information on how to contact the doctors as well as the MPN’s Medical Access Assistant.

A Medical Access Assistant (MAA) is a person assigned to help the injured employee find an available MPN doctor of the employee’s choice. They must be available from 7 AM to 8 PM Pacific Standard Time, Monday through Saturday. It is their duty to contact the doctor’s offices during regular business hours and schedule appointments. (See Labor Code §4616(a)(5) and Title 8, California Code of Regulations §§9767.1(a)(16) and 9767.5(h).)

An initial non-emergency care appointment must be scheduled within 3 business days and a non-emergency specialists care be scheduled within 20 business days. (See Title 8, California Code of Regulations §9767.5(f) and (g).) “If an MPN medical access Assistant is unable to schedule a timely medical appointment with an appropriate specialist within 10 business days of an employee’s request, the employer shall permit the employee to obtain necessary treatment with an appropriate specialist outside of the MPN.” Title 8, California Code of Regulations §9767.5(g).

Once you have located the MPN website information, search the list of doctors for an appropriate doctor or specialist, and select. Try to find the MAA’s contact information on the MPN website, and if you can find it, notify the MAA that treatment is needed, provide the name of the doctor selected, and request that they schedule an appointment. If you cannot find the MAA’s contact information on the MPN website, write to the carrier with a demand that the MAA from their MPN schedule an appointment within the time limits provided by the Regulations. If the MAA does not respond, consider filing a Request for Expedited Hearing with the WCAB with a demand that treatment with a doctor of your choice be authorized outside of the MPN.

If you encounter problems with an MPN, you have the option of filing a Medical Provider Network Complaint, which can be found here:

https://www.dir.ca.gov/dwc/DWCPropRegs/MPNRegulations/MPN-Final-%20Regulations/FORMS/MPNComplaintForm9767.16.5.Strikeout.pdf

Many of California’s injured workers say they don’t have a fighting chance to recover under a workers’ compensation claim. The Investigative Unit is digging into a system that many patients and doctors say unfairly denies medical care, and examining an appeals process critics claim rubber-stamps denials of critical treatment. NBC Bay Area learned that nearly 90 percent of the time, anonymous reviewers agree injured workers don’t need the medical treatment their doctors have requested to get them back on the job. Sometimes it can lead to devastating consequences. Liz Wagner reports in a story that aired on Aug. 24, 2016. (Published Wednesday, Aug. 24, 2016)

Source: Injured Workers Face Stacked Deck During Workers’ Comp Appeals Process, Critics Say | NBC Bay Area | Full story here

Some California’s injured workers say the system that is supposed to get them back to work is actually making their recoveries longer and more complicated. A California Highway Patrol officer injured in a collision with a drunk driver says the problem is too big to ignore. The Investigative Unit’s Liz Wagner reports in a story that aired on August 22, 2016. (Published Monday, Aug. 22, 2016)

Source: Workers' Comp Drags Out Medical Care, Injured Workers and their Doctors Say | NBC Bay Area | Full story here

A San Jose fire captain nearly died after a building collapsed on him, but the workers’ compensation system denied the medical treatments his doctor says he needed. The Investigative Unit learned his injury was captured on camera. Now he’s asking, if he can’t get treatment for an on the job injury – who can? Liz Wagner reports in a story that aired on August 13, 2016. (Published Sunday, Aug. 14, 2016). This story is the first part of an NBC Bay Area investigation into California’s workers’ compensation system. Check back on Aug. 22nd for Part II.

Source: Dozens of Injured San Jose Firefighters Denied Workers' Comp Treatment | NBC Bay Area | Full story here

It is recommended you file DWC-1 form within 30 days of your injury, but if you missed that deadline, here are the rules on when your claim may be denied for being past the “statute of limitations.”

• You have one year from the date of death to officially file your claim, if you are attempting to collect benefits on behalf of a relative who died due to a job-related injury.
• You have one year from the date of injury to officially file your claim, if the insurance company either denied or ignored your request for benefits, or report of injury.
• You will have five years from the date of injury to officially file your claim , If your employer’s insurance company provided benefits after the injury was reported (e.g., paid for your medical treatment or paid you for time off work).

You should contact a San Francisco Bay area workers’ compensation lawyer If you did not file a worker’s comp claim within the above time frames. An experienced lawyer can potentially discover if there are circumstances in which you can be excused for missing the statutes of limitations deadline, such as if your employer didn’t post the proper notices, or properly advise you of your right to file a workers’ comp claim.