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Poor Access to Medical Treatment Made Worse by Workers’ Compensation Carrier’s Conduct

On Behalf of | Dec 21, 2016 | Workers' Compensation |


Workers’ compensation carriers continue to disrupt an injured workers access to necessary and appropriate medical treatment. These efforts affect the system in many ways, including, but not limited to: (1) keeping workers on disability longer than necessary, (2) adding litigation costs to the system, (3) increasing permanent disability awards for injured workers due to lack of treatment, and (4) unnecessarily taking up the time of the workers’ compensation judges on such matters.

By way of example, I refer to a client of mine who sustained a low back injury in December 2014. Thereafter, he received conservative treatment with a doctor provided from the workers compensation carrier’s list of doctors, i.e., its medical provider network (“MPN”). However, several months after commencing treatment, this doctor left the MPN; this is not uncommon. Many doctors leave workers’ compensation medical provider networks due to the bureaucratic headaches associated with practicing medicine in the workers’ compensation field. Indeed, the bureaucracy in workers’ compensation makes that with private health insurance pale by comparison.

My client wished to continue treating with this doctor since he was familiar with his condition. Even though the doctor had been in the carrier’s MPN, the carrier refused to authorize continuing treatment with him. But, when we looked to transition to another doctor, the carrier’s MPN only had a couple of doctors within it in violation of the laws of the state. The carrier still would not permit continuing treatment with their formerly acceptable doctor. So, we filed a petition with the Workers’ Compensation Appeals Board (“WCAB”) to allow the client to treat outside of the carrier’s MPN. Unfortunately, this type of petition can take many months to be addressed leaving the client without any medical treatment in the interim. So, the client opted to pick one of the two doctors in the carrier’s MPN. The WCAB ultimately issued an order indicating that the client could treat with the first doctor since the carrier had not complied with the law regarding adequacy of physicians in the MPN. By this time (i.e., many months later), The client elected to stay with the second doctor since that care had commenced, and he did not want a further disruption in his treatment.

The, the carrier removed the second doctor from its MPN. We asked that the carrier continue to authorize treatment with the second doctor (1) given the inadequacy of the MPN and (2) the WCAB’s prior order regarding the first doctor. Seems like a no brainer, right? However, the carrier is only willing to authorize treatment outside the MPN for a short period. Astonishingly, the carrier is also appealing the WCAB order with regard to the first doctor even though he is no longer treating the Applicant. While Applicant no longer cares about treatment with the first doctor, he must now oppose the carrier’s position so that it does not have an ancillary impact on efforts to continue to treatment with the second doctor. Confused yet?

When I think of the time and energy for all parties associated with the workers’ compensation carrier’s legal and administrative shenanigans, the stress on my client, the time of the worker’s compensation judges, I am struck with the fact (as I am everyday) that there simply has to be a better system.


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