Mpn Transfer Care—who Is in Control and What Does That Mean?

• Publication year: 2021
• Author: Zachary M. Kweller, Esq.

MPN Transfer Care—Who Is in Control and What Does That Mean?

Zachary M. Kweller, Esq.

Oakland, California

An employer's right to medical provider network (MPN) control has been strengthened over time with the passage of SB 899 and again with SB 863. This article lays out a brief history of the right to medical control leading up to SB 863 and discusses post-SB 863 issues surrounding the MPN transfer of care, as well as some of the exceptions to the MPN transfer of care provisions. (The article does not address the ways to escape the MPN outside of CCR section 9767.9(e) and Labor Code section 4603.2(a)(2).)

What Is an MPN?

Under the California workers' compensation scheme, a medical provider network is a listing of physicians and medical groups from which an injured employee must choose, absent certain exceptions, for treatment of their industrial injury. The concept of an MPN was introduced with SB 899. Under SB 863, regulations were adopted to reinforce the employer's right to utilize an MPN and to make it easier for the employee to find physicians within the network.

Labor Code sections 4616 through 4616.7 and CCR sections 9767.1 through 9767.19 govern the requirements for establishment and maintenance of MPNs.

A Brief History of Medical Control and Establishment of the MPN

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Medical control simply refers to whether the employer or the employee has the right to choose a treating physician for an industrial injury. The employer has medical control when it has the ability to designate a physician or to provide a list of physicians from which the employee must choose. The employer typically has medical control within the first 30 days from the date of injury, whether or not an MPN has been properly established and when no exceptions to participation exist.

Conversely, the employee has medical control when they are free to choose a treating physician unconnected to the employer. Post-SB 863, the employee typically has medical control in the first 30 days when they properly pre-designate a physician and after 30 days when no MPN exists or the MPN is deficient for one or more reasons.

Medical Control Before 1976—Employer's Overwhelming Right to Control

Generally speaking, prior to 1976, where the employer made an unequivocal tender of reasonable medical treatment by way of a notice stating how, where, and with whom to treat, the employee had no right to choose a treating physician. The employee gained the right to choose only where an employer neglected to provide the requisite information or otherwise failed or refused to provide reasonable medical treatment.

Medical Control Effective January 1, 1976—A Shift to the Employee

Effective January 1, 1976, the Legislature retroactively amended Labor Code section 4600 to limit the employer's control to the first 30 days after the injury was reported. After the initial 30 days of control, the right to choose shifted to the employee, who was required only to choose a physician within a reasonable geographic distance, was able to change their choice at any time, and would be required to change from a selected physician only after an employer's petition and order showing good cause.

Medical Control with SB 899—A Game-Changing Shift Back to the Employer

On April 19, 2004, with SB 899, the concept of an MPN was introduced into the workers' compensation system. The MPN allowed an employer to continue to control treatment by limiting the employee's ability to select a new physician to only those physicians on a specific list of medical providers.

Under SB 899, the employer was able to effectuate transfer of care into the MPN if the employee received notice of their rights under the MPN, subject to four exceptions, discussed later in this article.

Medical Control with SB 863—Reinforcing the Employer's Right to Control

Effective January 1, 2013, by way of SB 863, several changes to the MPN statutes were made, with the most employer friendly...