California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 3.5 - Medical Provider Network › Section 9767.6 - Treatment and Change of Physicians Within MPN

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) When the injured covered employee
					 notifies the employer or insured employer of the injury or files a claim for
					 workers' compensation with the employer or insured employer, the employer or
					 insurer or entity that provides physician network services shall arrange an
					 initial medical evaluation with a MPN physician in compliance with the access
					 standards set forth in section
					 9767.5.
(b) Within one working day after an employee
					 files a claim form under Labor Code section
					 5401, the
					 employer or insurer shall provide for all treatment, consistent with guidelines
					 adopted by the Administrative Director pursuant to Labor Code section
					 5307.27 and as
					 set forth in title 8, California Code of Regulations, section
					 9792.20
et
					 seq.
(c) The employer or
					 insurer shall provide for the treatment with MPN providers for the alleged
					 injury and shall continue to provide the treatment until the date that
					 liability for the claim is rejected. Until the date the claim is rejected,
					 liability for the claim shall be limited to ten thousand dollars
					 ($10,000).
(d) The insurer or
					 employer shall notify the employee of his or her right to be treated by a
					 physician of his or her choice within the MPN after the first visit with the
					 MPN physician and the method by which the list of participating providers may
					 be accessed by the employee.
(e) At
					 any point in time after the initial medical evaluation with an MPN physician,
					 the covered employee may select a physician of his or her choice from within
					 the MPN. Selection by the covered employee of a treating physician and any
					 subsequent physicians shall be based on the physician's specialty or recognized
					 expertise in treating the particular injury or condition in question. If a
					 chiropractor is selected as a treating physician, the chiropractor may act as a
					 treating physician only until the 24-visit cap is met unless otherwise
					 authorized by the employer or insurer, after which the covered employee must
					 select another treating physician in the MPN who is not a chiropractor, and if
					 the employee fails to do so, then the insurer or employer may assign another
					 treating physician who is not a chiropractor.
(f) A Petition for Change of Treating
					 Physician, as set forth at section
					 9786, cannot be utilized to seek a
					 change of physician for a covered employee who is treating with a physician
					 within the MPN.
1. New
						section filed 11-1-2004 as an emergency; operative 11-1-2004 (Register 2004,
						No. 45). A Certificate of Compliance must be transmitted to OAL by 3-1-2005 or
						emergency language will be repealed by operation of law on the following
						day.
2. New section refiled 2-28-2005 as an emergency; operative
						3-1-2005 (Register 2005, No. 9). A Certificate of Compliance must be
						transmitted to OAL by 6-29-2005 or emergency language will be repealed by
						operation of law on the following day.
3. New section refiled
						6-20-2005 as an emergency; operative 6-29-2005 (Register 2005, No. 25). A
						Certificate of Compliance must be transmitted to OAL by 10-27-2005 or emergency
						language will be repealed by operation of law on the following
						day.
4. Certificate of Compliance as to 6-20-2005 order, including
						amendment of section, transmitted to OAL 7-29-2005 and filed 9-9-2005 (Register
						2005, No. 36).
5. Amendment of subsections (b) and (f) filed
						8-9-2010; operative 10-8-2010 (Register 2010, No. 33).
6. Amendment
						of subsections (a) and (e) and amendment of NOTE filed 8-27-2014; operative
						8-27-2014 pursuant to Government Code section
						11343.4(b)(3)
						(Register 2014, No. 35).
Note: Authority cited: Sections
						  133 and
						  4616(h),
						  Labor Code. Reference: Sections
						  4604.5,
						  4616,
						  4616.3,
						  5307.27 and
						  5401, Labor
						  Code.