SB 863 provides many changes to the MPN landscape. Labor Code section 4603.2(a)(2) now reads, “If the employer objects to the employee’s selection of the physician on the grounds that the physician is not within the medical provider network used by the employer, and there is a final determination that the employee was entitled to select the physician pursuant to Section 4600, the employee shall be entitled to continue treatment with that physician at the employer’s expense.”
This is most significant for denied cases later accepted. Previous cases held the employer’s right to transfer the employee back into the MPN after acceptance of injury. This was important in times when immediate care was needed but the employer required additional time to decide on denial of the claim.
There does appear to be a limitation to only that physician. Further, there are notification and reporting standards the non-MPN physician must adhere to in order to be compensated under the Code.
On the flip side, Labor Code section 4603.2(a)(3) now reads, “If the employer objects to the employee’s selection of the physician on the grounds that the physician is not within the medical provider network used by the employer, and there is a final determination that the employee was not entitled to select a physician outside of the medical provider network, the employer shall have no liability for treatment provided by or at the direction of that physician or for any consequences of the treatment obtained outside the network.”
The first significant result of this new Section is that so long as employee is not entitled, any referrals for other services or consultations “at the direction of [the non-MPN physician]” will not be liable by the employer.
The second significant result is that “any consequences of the treatment obtained outside the network” will likewise not be compensable. It appears that not only would the employer not be liable for the medical payments but neither would they be liable for indemnity or other benefits as a result of consequential injuries.
So the important question is how do we know if the employee is permissibly or impermissibly treating outside the MPN. Labor Code section 5502(b) now specifically allows for issues regarding whether the injured employee is required to obtain treatment within the MPN to be heard on an expedited basis. Further, the Section states that “no other issues may be heard until the medical provider network dispute is resolved.”
Ultimately, it seems that any disputes in these regards can be heard sooner than later. Hopefully, this will severely reduce the need for litigation post-settlement in regards to liens of non-MPN physicians, their consultants and other providers.