California Banner 2012 Chess Board
Vol. 3, Issue 5

Find Solutions & Strategies                           January 30, 2012

Medical Provider NetworkMedical Provider Networks 101
A trio of recent panel decisions serves as a guide to navigating MPN issues
In This Issue
* BLOG ROUND UP: Fraud, CCC's, AMA-based ratings
* WCJ NEWS: Gordon, Johnston
* NEWS HEADLINES: WCRI study - rise in indemnity costs per claim

A Note From the Editor

Robin Kobayashi 2010

Dear WC Professionals:  


In this issue we've given you a mini-guide to navigating MPN issues, with a focus on three recent panel decisions: Clifton, Zarco, and Paris.



Robin E. Kobayashi, J.D.
LexisNexis Legal & Professional Operations

Free eNewsletter

Mailbox red

Sign up for this free eNewsletter by sending your full name and email address, along with your request for the Calif. edition, to:

Lawyer's Guide to AMA Guides

 1432 R2012 Edition cover

New 2012 Edition

By Robert G. Rassp, Esq.


Order Print Version.


Order eBook.

Apple® iPad®, SONY® Reader and other ereaders


Order eBook.

Amazon® Kindle™ and other Mobipocket readers

navigating mpn's: clifton & zarco

Navigating MPN Issues. There have been several cases as of late addressing MPN issues. Specifically, there has been Knight v. United Parcel Service (2006) 71 Cal.Comp.Cases 1423 (Appeals Board en banc) where it was held "that an employer or insurer's failure to provide required notice to an employee of rights under the MPN that results in a neglect or refusal to provide reasonable medical treatment renders the employer or insurer liable for reasonable medical treatment self-procured by the employee."


And, more recently, there has been Valdez v. Warehouse Demo Services (2011) 76 Cal.Comp.Cases 330 and 76 Cal.Comp.Cases 970 (Appeals Board en banc), where it was held where there has been unauthorized treatment obtained outside a validly established and noticed MPN, reports from the non-MPN doctor are inadmissible and defendant is not liable for the cost.


The question that often arises is how does a defendant prove that it sent the proper notices in compliance with Knight, and when exactly will a defendant be liable for treatment procured outside of the MPN? Recently, a panel of commissioners with the Workers' Compensation Appeals Board addressed these issues... > Read more

treatment outside mpn: paris

Another Nuance to Treatment Outside of the MPN. There have been many cases as of late dealing with Medical Provider Network issues. Valdez v. Warehouse Demo Services (2011) 76 Cal. Comp. Cases 970 held that treatment reports obtained by physicians outside of the defendant's MPN were not admissible and defendant was not liable for the cost. As with any legal issues, there are often exceptions to the general rule. For example, what happens if the injured worker files a claim of injury to multiple body parts and the defendant accepts some but not all of the body parts? That was precisely the issue presented in a recent panel decision... > Read more


1652 banner subscribers: Get the cutting edge on case law. Subscribe today to the California WCAB Noteworthy Panel Decisions Reporter.

ama guides: central nervous system

Robert Rassp graySomething for Everyone: The AMA Guides and the Central Nervous System, by Robert G. Rassp, Esq. AMA Guides, Chapter 13 on the central and peripheral nervous system, is one of the most important chapters in the Guides for our purposes as workers' compensation attorneys. In most of our workers' compensation cases, if there is any evidence of sensory or motor deficits, regardless of the part of body injured (head, brain, back, neck, upper extremities, lower extremities), then you should make sure the physician considers the criteria in this AMA Guides Chapter 13 in addition to any other applicable AMA Guides chapter for the specific body part(s)... > Read more

blogs at the lexisnexis workers' comp law community 


Fraud Sign

Workers' Comp Fraud Blotter -  Claimant Guilty of Mining for Gold in California, by LexisNexis Workers' Compensation Law Community Staff. Read it.




Cal Comp CasesProbation Dept. Counselor Stumbles on Way to Break Up Classroom Fight Between Juvenile: Cal. Comp. Cases January Advanced Postings. Here's the fourth batch of advanced postings for the January 2012 issue of Cal. Comp. Cases. subscribers can access the complete headnotes. Read it.



Julius Young thumbnailBy the Numbers, by Julius Young, Esq. What was the impact of the adoption of an AMA-based permanent disability rating schedule in California? That was the question addressed in a significant new study by Frank Neuhauser, Executive Director of the UC Berkeley based Center for the Study of Social Insurance. Read it.



> Hon. Terri Ellen Gordon is now a judge at the San Francisco District Office.

> Hon. Rodney M. Johnston will transfer to the Pomona District Office, effective 2/1/2012.


CA: WCRI Says Faster Growth in Indemnity Costs Per Claim May Reflect Impact of Recession.

CA: SCIF Pays Out $30M to 971 Employees, 705 Jobs Remain to Be Cut.

CA: DWC Public Disability Accommodation Rules Effective Feb. 18.

CA: Millbrae Woman Arraigned for Payroll Theft, Workers Comp Premium Fraud.

CA: Mother, Daughter Caregivers Charged With Workers Comp Insurance Fraud.

S&P Says More Unprofitable Years Ahead for Workers Comp Insurance Industry.

NCCI Releases Report on Workplace Violence.

GAO Says FECA Remains Vulnerable to Fraud.

IAIABC, SIGFA Announce Partnership for 2012.

NIOSH Warns of Cold Stress Work-Related Injuries.

AIG Ratings Outlook Now Stable According to A.M. Best.

Lexington Insurance (Chartis) Announces LexTV Episodes.

Crawford & Company Shares Downgraded to "Neutral".

Accident Fund Insurance Names Cambridge Underwriters Its Agency of the Year.

enewsletter archives

Take a deep dive into our past eNewsletters for 2012 and prior...warning - some links to articles may not any linking problems to

January 23, 2012: Comfortably Numb: Prescription Pain Medications.
November 28, 2011: The Non-Examining Panel QME.
LexisNexis and the Knowledge Burst logo are registered trademarks of Reed Elsevier Properties Inc., used under license. Other products or services may be trademarks or registered trademarks of their respective companies.

Privacy & Security Copyright © 2012 LexisNexis, a division of Reed Elsevier Inc. All rights reserved.