For an injured worker in California, understanding medical provider networks (MPNs) is only the first hurdle to receiving the treatment you need. While the process should ideally be as easy as choosing a doctor in the MPN, the tangled bureaucracy and strict rules of these networks can stall your recovery before it starts. To successfully avoid indefinite delays, you must take initiative. The following steps outline exactly how to verify your network, secure an appointment, and if necessary, legally enforce your right to medical attention.
Step #1: Obtain the MPN Provider Directory
Being treated through a California workers’ compensation MPN functions similarly to using a standard HMO, in that you must select a physician from a specific list to have your care covered. The difference is that you do not choose the network based on your preferences; the insurance carrier selects the providers themselves.
To begin treatment, you must obtain the specific directory of doctors for your employer’s MPN. This list is not always automatically provided to you by your employer; you often have to take initiative to find it.
How to Locate the MPN List:
- Check Your Notices: When your claim is accepted or transferred into the MPN, you are legally required to receive a document titled the Complete Written MPN Employee Notification (View Example PDF Here). This letter contains the specific website URL and access code for your network.
- Access the Online Portal: Most insurance carriers use third-party services to host their lists. You will likely need to search for your employer’s name on portals like CorVel or TalisPoint. Look for a link labeled Roster of Treating Physicians or Provider Directory.
- Contact the Adjuster: If you cannot find the notification letter, email your claims adjuster immediately. Request a copy of the MPN provider directory in writing.
Legally, your list must contain a minimum of three physicians in each medical specialty who meet specific geographic standards. However, while the law requires these options to exist on paper, it does not mandate that the list be user-friendly. As a result, these lists are often delivered as large, difficult-to-search PDFs or confusing websites, which makes verifying physician availability critical.
Step #2: Verifying Physician Availability
Possessing the provider list is not the same as having access to care. While the law requires the directory to be accurate, the burden falls entirely on the injured worker to vet the list and find a physician who is ready, willing, and able to accept the case.
This stage often presents the most significant barrier to treatment. Workers frequently encounter “phantom” listings: doctors who have retired, moved to different medical groups, or stopped accepting workers’ compensation insurance entirely due to payment disputes. It is common for an injured worker to call five or six doctors before finding one who can actually schedule an appointment.
Legally, the MPN must provide a primary treating physician within a reasonable distance, which is defined as 15 miles or 30 minutes from your home or workplace. If you cannot find an available doctor within these limits who is willing to treat you, the network may be considered inadequate. This distinction is important: demonstrating inadequacy is the only way to gain the right to seek treatment with a doctor outside of the network.
To protect this right, you must document your efforts. Do not just make calls; keep a written log. If you eventually need to petition a judge for treatment outside the network, this log will be your primary evidence that the MPN failed to provide access.
What to Ask When You Call About MPN Availability:
- “Are you currently accepting new workers’ compensation patients?”
- “Are you part of the [Specific MPN Name] network?” (Confirm this, as lists are often outdated.)
- “Can you schedule an initial appointment within 3 business days?” (This is the legal access standard for non-emergency treatment).
- If they say no: Write down the date, the person you spoke to, and the specific reason for the denial.
Step #3: Securing Authorization and Records Transfer
Once you have verified that a doctor is available, you cannot simply show up for an appointment. You must first clear the administrative hurdle of authorization. To do this, you must inform the insurance carrier of your choice and provide them with the doctor’s specific contact information. The best way to handle authorization is through email, which creates a timestamped record of communications.
Once notified, the claims adjuster is required to transmit two essential forms of documentation to your new physician:
- Written Authorization: A formal confirmation that the insurer will pay for the visit.
- Medical Records: A copy of your injury history so the doctor knows what they are treating.
This step is a common bottleneck, as the timing depends entirely on the schedule of the adjuster and the physician. The wait time for this paperwork transfer could range from a matter of days to months. If you visit the doctor before this written authorization is received, the insurance company is not obligated to pay for the visit, and you may be turned away at the front desk.
Step #4: Changing Physicians or Requesting Specialist Referrals
If your assigned doctor is ineffective, dismissive, or not helping you recover, you are not trapped. Injured workers have the right to change treating physicians at any time. However, how you proceed depends on whether you are swapping your primary doctor or seeking a specialist.
- Switching Treating Physicians in the MPN: To switch doctors, you must select a new physician from the MPN list and verify they are available to accept a transfer of care. Once you have made your selection, you must notify your claims adjuster in writing. The adjuster then has to authorize the transfer and send your medical records to the new office.
- Requesting an MPN Specialist Referral: The process becomes even more time-sensitive when you need advanced care (like an MRI, surgery, or neurology consult). In the MPN system, your primary treating physician acts as the gatekeeper. You cannot call a specialist directly; your primary doctor must write a formal referral.
Once a referral is made, the MPN is legally required to provide an initial appointment with a specialist within 20 business days. Travel standards vary slightly, as primary doctors must be within 15 miles or 30 minutes of travel time, while specialists must be within 30 miles or 60 minutes travel time.
If the MPN cannot provide a specialist within these time or distance limits, the insurance company generally must authorize an out-of-network specialist. This often requires legal counsel to enforce, as carriers rarely volunteer this information.
Step #5: Enforcing Continuity of Care (If Your Doctor is Removed)
Workers’ compensation insurance companies hand-pick their networks, which means they also have the unilateral authority to remove medical providers from them. If your treating physician is removed from the MPN mid-treatment, the carrier will typically demand you transfer to a new provider immediately.
However, forcing a patient to switch doctors during active treatment can be medically harmful. Under California Labor Code Section 4616.2, injured workers may argue that a transfer would disrupt the MPN continuity of care. If you meet specific legal criteria, you may be entitled to continue treatment with your original doctor even after they have been removed from the network. These criteria include:
- Acute Condition: You may complete treatment for the duration of the condition (if the duration is less than 90 days).
- Serious Chronic Condition: You may generally keep your doctor for up to 12 months from the contract termination date.
- Pending Surgery: If you have a surgery already authorized and scheduled to occur within 180 days of the termination date.
If the insurance carrier denies this request, a workers’ compensation judge will need to intervene to determine if the transfer would be detrimental to your recovery.
Step #6: Litigating Disputes and Inadequate Networks
If you have followed the previous steps and find that no providers are available within the legal time or distance standards, the administrative process has failed, and the network can legally be deemed inadequate. The only way to formally prove inadequacy and enforce your rights is through litigation, typically with the assistance of specialized workers’ compensation attorneys.
Once a judge finds the network inadequate, the injured worker may be granted the right to seek treatment from a doctor outside the network. However, this requires significant effort and evidence to achieve.
How a Workers’ Compensation Attorney Can Help:
- Presenting Your Case: An attorney takes the detailed call logs and written correspondence you created in the earlier steps and formally presents them to a workers’ compensation judge as proof that the MPN failed to meet its access standards.
- Forcing Compliance: When an insurance company refuses to authorize care, an attorney’s primary role is to compel them into court to explain their conduct and follow the law.
- Securing Care Outside the MPN: By successfully arguing that the MPN is inadequate, an attorney can secure a judge’s order granting you the right to treat with a doctor outside of the network.
Fight MPN Delays With the Help of Experienced Workers’ Comp Attorneys
The MPN system relies on the fact that injured workers are often too exhausted or in too much pain to fight back against delays, but you don’t have to face it alone. If you are struggling to find a doctor or if your care is being delayed, it is time to get professional help.
For over 30 years, the Law Office of Kneisler & Schondel has dedicated its practice to defending injured California workers. As certified specialists in workers’ compensation law, our team possesses an in-depth mastery of the CA MPN system, allowing us to enforce regulations and hold insurance carriers strictly accountable. In doing so, we help to prove when a network is inadequate and protect your right to see a doctor who will prioritize your recovery.
If your MPN is delaying treatment or denying your choice of doctor, you have the right to fight back. Schedule a free consultation now to get the support you need.
Medical Provider Network (California): Frequently Asked Questions
How Do I Find a Doctor in the MPN?
You must request the provider directory from your insurance adjuster and call the doctors listed by specialty until you find one who is available and willing to accept your workers’ compensation claim.
Can I Switch My Treating Physician in the MPN?
Yes. You may change treating physicians at any time, provided the new doctor is also within the MPN. The process requires selecting a new doctor from the list and having the adjuster authorize the transfer of care.
What Is MPN Continuity Of Care?
Continuity of care allows an injured worker to temporarily continue treating with a doctor who has been removed from the MPN. This applies if the worker has an acute condition, a serious chronic condition, or a surgery scheduled within 180 days.
What If the MPN Has No Specialists?
If the MPN lacks a necessary specialist within the required access standards (typically 30 miles or 60 minutes), the insurance company is generally required to authorize treatment with a specialist outside the network. This typically requires legal intervention to enforce.