Workers’ Compensation Proceedings: There’s More Than One Way To . . .

Labor Code section 4605 gives employees the right to retain consulting or attending physicians at their own expense for workers’ compensation proceedings. Labor Code section 4616.3 requires the employer to notify the injured employee of the existence of medical provider networks [MPNs], as well as the employee’s right to change treating physicians within the network after the first visit. Accordingly, an employee who disputes the employer’s diagnosis, or treatment provided by the MPN doctor has two choices. The employee may seek an opinion from a different MPN doctor, and if the dispute persists after seeing three MPN doctors, the employee may request an independent medical review under Labor Code section 4616.4, subsection (b). Or, the employee may obtain another evaluation at the employee’s own expense. In the present case, the employee, after being dissatisfied with the first MPN doctor, did not ask to see a second or third MPN doctor, but sought treatment outside the network. The employer objected to the report of the non-MPN doctor at the disability hearing. The workers’ compensation judge admitted the report and awarded disability benefits. The Workers’ Compensation Appeals Board rescinded the judge’s determination and held the admission of the non-network report was precluded under the law. Both the Court of Appeal and the California Supreme Court determined the Board was wrong, and that a party may obtain an outside report at the party’s own expense and that report is admissible at the hearing. (Valdez v. Workers’ Compensation Appeals Board  (Cal. Sup. Ct.; November 14, 2013) 57 Cal.4th 1231.)