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By Robert G. Rassp, Esq.

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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

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

Something 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