California’s Medical Provider Network (MPN) system is broken beyond repair, to the point where finding an MPN doctor is simply impossible for many injured workers.
We’re speaking from experience, having recently tried it ourselves.
A daisyBill employee received a DWC 7 form outlining their basic rights and responsibilities in the event of a work-related injury. The form identified American Zurich Insurance Company as daisyBill’s workers’ comp insurer, and Sedgwick as the Third-Party Administrator (TPA) managing daisyBill claims on Zurich’s behalf.
Below, we share our attempt to identify an eligible MPN doctor for our (hypothetical) injured employee. Spoiler alert: after a tortuous online odyssey, we couldn't identify a single one.
The California MPN system is a labyrinth of profit-seeking entities and vendors that serves no discernible functions other than fattening themselves on employer dollars and enabling provider payment abuse. Injured workers are the collateral damage.
See for yourself.
Below is the DWC 7 form listing Sedgwick (yeah…that Sedgwick) as daisyBill’s claims administrator and American Zurich Insurance Company as daisyBill’s workers’ compensation insurer.
The DWC 7 instructs our employees on obtaining care if they sustain an injury at work. The form indicates an MPN but fails to list an MPN website where an employee can choose an MPN physician in the event of an injury, leaving our employees no way to access care.
The DWC 7 provided some MPN information, including:
To identify the MPN, we went to the California Division of Workers’ Compensation (CA DWC)’s online MPN list (which your average injured worker almost certainly does not know exists).
We entered MPN ID number 2385 into the “Search” field, hoping that among the 2,525 MPNs on the list (most of which are terminated, suspended, or otherwise defunct), we could find the one our employee must use when seeking treatment.
According to the CA DWC list, for MPN ID 2385:
All of these vendors and other entities add indecipherable layers of complexity and employer cost—while contributing nothing to the actual care of injured workers.
Clicking the web link on the CA DWC MPN list brought us to a random Enlyte landing page (Enlyte is the parent company of Coventry) rather than any specific MPN page listing physicians for the daisyBill employee to review.
To find anything regarding specific MPN physicians, we had to scroll through miles of marketing materials to find the ‘MPN PROVIDER INFORMATION’ buried at the bottom.
Clicking the Enlyte ‘MPN PROVIDER INFORMATION’ link led us to a Coventry page where (finally!) we could search for eligible providers in our “injured” employee’s area.
…or so we (mistakenly) thought.
As it turned out, the Coventry search function is for providers to check and acknowledge their MPN status, rather than for injured workers to find a doctor.
California law mandates that every injured worker is able to call a human being, known as a Medical Access Assistant (MAA), to assist in finding available MPN physicians. Per Labor Code § 4616 (emphases ours):
The DWC 7 form sent to the daisyBill employee states, “If you need help locating an MPN physician, call your MPN access assistant at 866-274-6586.” Sedgwick also listed the same number for the “MPN Contact Person.”
We called the number—and it was simply Sedgwick's main business number.
No menu items on the recorded greeting mentioned finding an MPN provider. There was no information about Coventry, Cannon Cochran, or whoever is supposed to be in charge of the MPN. Rather than climbing around the phone tree in hopes of finding someone who could help, we did what many injured workers likely do: tapped out.
Even as workers’ comp professionals, we could not successfully navigate the MPN cesspool and find a list of physicians eligible to treat one of our employees.
California’s MPN system is a black hole of opaque vendor and “entity” relationships, online dead ends, and unenforced laws and regulations—funded entirely by employer dollars. Coventry, Sedgwick, Enlyte, Cannon Cochran, and many more gorge themselves on profit while doing little or nothing to facilitate care.
Meanwhile, the CA DWC maintains its silence and inaction, keeping the MPN system broken.
DaisyBill provides content as an insightful service to its readers and clients. It does not offer legal advice and cannot guarantee the accuracy or suitability of its content for a particular purpose.