The Appeals Board has put their foot down on non-medical provider network reports. In the En Banc decision of Elayne Valdez v. Warehouse Demo Services, the WCAB held that, where unauthorized medical treatment is obtained outside a validly established and properly noticed Medical Provider Network (MPN), reports from the non-MPN doctors are inadmissible, may not be relied upon, and Defendant is not liable for their cost.
In this claim, the Applicant was properly treating within the MPN for three weeks, then changed to a non-MPN physician based on the recommendation of her attorney. At the time, Applicant had made no complaints regarding the nature of her treatment or made any demand to change treating physician. Applicant was certified for temporary disability benefits based on the reporting of the non-MPN physician. At trial, the WCJ awarded Applicant TD benefits based on these reports. Defendant appealed arguing the reports were inadmissible.
The WCAB held “…that where unauthorized treatment is obtained outside a validly established and properly noticed MPN, reports from the non-MPN doctors are inadmissible, and therefore may not be relied upon, and that defendant is not liable for the cost of the non-MPN reports.”
Of course there were dissenting opinions. Commissioner Caplane agreed Defendant is not liable for the cost of these reports but felt the reports should still be considered evidence as to the issue of compensation. Commissioner Brass dissented because there may be situations when an injured worker has good reasons to seek care outside even a validly established and properly noticed MPN, and thus, an appropriate exercise of authority under section 5703(a) would be to admit the reports of the non-MPN treating physician. However in the instant case, Commissioner Brass felt Applicant failed to make a good faith attempt to treat within the MPN and as such the change of physician was inappropriate and should not be condoned.
Although this decision is a victory for Defendants, do not celebrate yet. This defense still requires evidence that a proper MPN was established. All notice requirements must be met in order to assert a proper MPN defense. Also it is highly likely that this case will be taken up on appeal. Until then, make sure all MPN notice requirements are completed and continue to object to non-MPN treatments.