A Medical Provider Network (MPN) is a group of health care providers (physicians and other types of providers) set up by an insurer or self-insured employer and approved by the Division of Workers’ Compensation’s Administrative Director to treat workers injured on the job. Each MPN must include a mix of doctors specializing in work-related injuries and doctors with expertise in general areas of medicine. MPN’s must meet access to care standards for common occupational injuries and work-related illnesses. Further, the regulations require MPN providers to use medical treatment guidelines adopted by the Department of Workers’ Compensation.

MPN’s must allow employees a choice of provider(s) in the network after the employee’s first visit.

California State Senate bill 899 that became law in 2004 provides that employers may establish an MPN as an integral part of the workers' compensation cost reduction program.

The MPN consists of providers that are familiar with and that practice industrial medicine in the workers' compensation arena.

The County has identified the following person / department to be the MPN contact for all employees:

Lisa Dearmore, Claims Manager
Workers' Compensation Services
County of Kern
1115 Truxtun Ave., 4th Floor
Bakersfield, CA 93301
1-855-372-5390
ldearmore@kerncounty.com

These people or any workers’ compensation claims adjuster will be able to answer your questions about the County of Kern MPN and tell you how to receive or access the names of the doctors in the MPN. A list of MPN providers is available at the MPN webpage.

You may use any provider that is a member of the MPN.

Pre-designation is still allowed. The pre-designated physician must be a M.D. or a D.O. who has previously treated you, is your primary treating physician under the County’s health plan, has your medical record on file and agrees to treat and report according to the regulations of the California Labor Code as set forth under Title 8 CCR § 9785.

You should select the physician that has regularly treated you and that has your medical records. You may not pre-designate a chiropractor or acupuncturist.

If you have a pre-designated doctor, that doctor will provide the initial treatment for any industrial injury or illness.

After the first visit, you may continue to be treated by this doctor, or you may choose another doctor from the County of Kern MPN. You may continue to choose doctors within the MPN for all your medical care for this injury. If appropriate, you may choose a specialist or ask your treating doctor for a referral to a specialist. If you need help in choosing a doctor or have trouble getting an appointment with a doctor within the MPN, you may call or e-mail the MPN Contact listed above.

If you are temporarily working outside the County of Kern MPN service area, you may be treated by any Hospital Emergency Room or Urgent Care Facility on an emergency basis. If you are in a situation where a particular specialist is not available in your area, please contact the MPN Contact. You may have a right to see a specialist outside of the MPN in this case.

In case of emergency, you should call 911 or go to the closest hospital emergency room for treatment. Otherwise, if you are injured at work, notify your employer as soon as possible. Your employer will provide you with a claim form. When you notify your employer or Workers’ Compensation Services that you have had a work-related injury, your employer or Workers’ Compensation Services will arrange an initial appointment with a doctor in the County of Kern MPN.

If you disagree with either the diagnosis or treatment prescribed by your doctor, you may ask for a second opinion from another doctor within the County of Kern MPN. If you want a second opinion, you must contact your claims adjuster and tell them you want a second opinion. The contact person will provide you with a list of MPN doctors from which to choose. Then you may choose a doctor from the County of Kern MPN and make an appointment within 60 days. You must tell your claims adjuster of your appointment date.

If you do not make an appointment within 60 days, you will not be allowed to have a second opinion with regard to the disputed diagnosis or treatment of the treating physician.

If the second opinion doctor feels that your injury is outside of the type of injury he or she normally treats, the doctor’s office will notify Workers’ Compensation Services and you will be given a new list of County of Kern MPN doctors or specialists so you can make another selection.

After you receive a second opinion, if you still disagree with your doctor, you may ask for a third opinion. If you want a third opinion, you must contact your adjuster and tell them you want a third opinion. They will make sure you have a list of County of Kern MPN doctors to choose from. Then you may choose a doctor from the County of Kern MPN and make an appointment within 60 days. You must tell your claims adjuster of your appointment date.

If you do not make an appointment within 60 days, then you will not be allowed to have a third opinion with regard to this disputed diagnosis or treatment of this treating physician.

If the third opinion doctor feels that your injury is outside the type of injury he or she normally treats, the doctor’s office will notify your claims adjuster and you will be given a new list of County of Kern MPN doctors or specialists so you can make another selection.

If after the third opinion, you still disagree with your doctor, you may ask for an Independent Medical Review (IMR). Your Claims adjuster will give you information on requesting an Independent Medical Review and a form on which to request an independent medical examiner from the Administrative Director.

A physician outside the MPN will be selected to conduct an independent assessment of your dispute and do an Independent Medical Review.

As long as your second opinion, third opinion or Independent Medical Reviewer agrees with the treating doctor, you will need to continue to receive your medical treatment with the doctors in the County of Kern MPN network.

If the Independent Medical Reviewer does not agree with your treating doctor, second opinion, or third opinion doctor you will be allowed to receive that treatment from a provider either inside or outside the County of Kern MPN. If you decide to receive treatment outside the MPN, it can only be for treatment or diagnostic service recommended by the Independent Medical Reviewer.

Once this treatment is completed, you will receive all other treatment from a doctor of your choice from the MPN Network.

The County has a Transfer of Care policy that describes what will happen if you are currently being treated for a work-related injury with a physician who is not a member of the MPN.

If your current treating doctor is a member of the County of Kern MPN, then you may continue to treat with this doctor and your treatment will be under the County of Kern MPN.

If your current treating doctor is not allowed to become a member of the County of Kern MPN, then you will be notified and given a choice of doctors within the MPN to choose for further treatment. Your doctor will also be notified in writing.

You will not be immediately transferred to a doctor in the County of Kern MPN if your injury or illness meets any of the following conditions:

• Acute: An acute condition is a medical condition that involves a sudden onset of symptoms due to illness, injury, or other medical problem that requires prompt medical attention and that has duration of not more than 30 days. Completion of treatment shall be provided for the duration of the acute condition before transfer of care is undertaken.
• Serious or Chronic: A serious or chronic condition is a medical condition due to disease, illness, catastrophic injury, or other medical problem or medical disorder that is serious in nature and that persists without full cure or worsens over 90 days and requires ongoing treatment to maintain remission or prevent deterioration. Completion of treatment shall be authorized for a period of time necessary, up to one year: (A) to complete a course of treatment approved by the County; and (B) to arrange for transfer to another provider within the MPN, as determined by the County. The one-year period for completion of treatment starts from the date of determination that the employee has a serious chronic condition.
• A Terminal Illness: A terminal illness is an incurable or irreversible condition that has high probability of causing death within one year or less. Completion of treatment shall be provided for the duration of a terminal illness.
• Pending Surgery or Procedure: Surgery or another procedure that is authorized by the adjuster as part of a documented course of treatment and has been recommended and documented by the provider to occur within 180 days from the MPN coverage effective date.

If the County of Kern MPN is going to transfer your care and you disagree, you may ask your treating doctor for a report that indicates whether you are in one of the categories listed above.

If either the County of Kern MPN or you do not agree with your treating doctor’s report, this dispute will be resolved according to Labor Code Section 4062. You must notify your Claims Adjustor assigned to this case if you disagree so the dispute resolution can be initiated.

If the treating doctor agrees that your condition does not meet one of the conditions listed above, the transfer of care will go forward while the dispute resolution is in process.

If the treating doctor believes that your condition does meet one of the conditions listed above, you may continue to treat with him or her while the dispute resolution is in process.

The County of Kern has a written Continuity of Care policy that may allow you to continue treatment with your doctor if your doctor is no longer actively participating in the County of Kern MPN.

If you are being treated for a work-related injury in the County of Kern MPN and your doctor no longer has a contract with the MPN, your doctor may be allowed to continue to treat you if your injury or illness meets one of the following conditions:

• Acute: An acute condition is a medical condition that involves a sudden onset of symptoms due to illness, injury, or other medical problem that requires prompt medical attention. An acute condition by definition is limited to not more than 30 days. Completion of treatment shall be provided for the duration of the acute condition.
• Serious or Chronic: A serious or chronic condition is a medical condition due to disease, illness, catastrophic injury, or other medical problem or medical disorder that is serious in nature and that persists without full cure and requires ongoing treatment to maintain remission or prevent deterioration. Treatment by the current treating doctor will be allowed, for up to one year or until a safe transfer of care can be made, which ever is less.
• A Terminal Illness: A terminal illness is an incurable or irreversible condition that has high probability of causing death within one year or less. Completion of treatment shall be provided for the duration of a terminal illness.
• Pending Surgery or Procedure: You already have a surgery or other procedure that has been authorized by your claims adjuster that will occur within 180 days of the MPN effective date.

If any of the above conditions exist, County of Kern MPN may require your doctor to agree in writing to the same terms as he or she agreed to when they were a provider in the County of Kern MPN Network. If the doctor does not, they may not be able to continue to treat you.

If the contract with your doctor was terminated or not renewed by County of Kern MPN for reasons relating to medical disciplinary cause or reason, fraud or criminal activity, you will not be allowed to complete treatment with that doctor.

The MPN listing was developed by the Workers' Compensation Services unit of the Office of the County Counsel and was approved by the State of California Division of Workers' Compensation.

Discuss the perceived need with the Workers' Compensation claims adjuster handling your claim. The adjuster will make the determination.

The MPN is very encompassing. It is not anticipated that additional providers will be added to the list, except to replace providers that may be removed.

You may always contact your claims adjuster or the MPN Contact as listed above or you may check the MPN website. Contact are also available at the CA Division of Workers' Compensation.

• DWC information and assistance officer: If you have concerns, complaints or questions regarding the MPN, the notification process, or your medical treatment after a work-related injury or illness, you can call the Information and Assistance Officer at the division of Workers’ Compensation at 1-800-736-7401.

• Independent Medical Review: If you have questions about the Independent Medical Review process or the Independent Medical Reviewer, you may contact the Division of Workers’ Compensation Medical Unit at:

  P.O. Box 8888
  San Francisco, CA 94128-8888
  (650) 737-2700 or (800) 794-6900