Zurich - An Example of California's MPN Shell Game

June 21, 2021 7 min read

By: the daisyNews Team

Zurich - An Example of California's MPN Shell Game

Where opacity and obfuscation reign, injustice thrives. There may be no better example of this than California’s Medical Provider Network (MPN) system.

Throughout California, claims administrators use MPNs to restrict injured workers’ access to care and improperly deny payment to providers. Unfortunately, providers face a monumental struggle in attempting to direct workers’ care and dispute these invalid denials—because the Division of Workers’ Compensation (DWC) has failed to furnish stakeholders with essential MPN information.

Despite the crucial role MPNs play in California workers’ compensation, it is often impossible for stakeholders to determine:

Which, if any, MPN applies to an injured worker’s employer
Which providers are listed in the MPN’s roster

In essence, the chaos of the MPN system allows claims administrators to play a shell game, denying care and payment for that care based on MPNs that—at any point—may or may not be valid, and may or may not include the treating provider.

Using just one claims administrator (Zurich Insurance North America) as an example, below we demonstrate how the DWC’s failure (or refusal) to share critical MPN information makes it impossible for injured workers and providers to protect themselves from MPN abuse.

Zurich’s Bloated MPN Collection

California law instructs that it is the DWC’s responsibility to ensure that each employer’s MPN has enough physicians within the applicable geographic area to treat the injuries common to the employees’ occupation or industry.

To adhere to this law, the DWC has to know:

Every employer’s MPN, and
The providers listed in the MPN.

However, the DWC has failed to provide this information to the public. Instead, the agency leaves stakeholders floundering in a swamp of 2,505 MPNs, with no reliable access to the MPN details necessary to facilitate care.

As just a single example of the MPN chaos, below is the list of the 83 approved MPNs the DWC lists for Zurich, of which ten are active as of this writing.

We have no idea (nor does anyone outside Zurich) of the names of the providers listed in the Zurich MPNs; clicking the MPN website, www.zurichna.com, does not navigate to any provider roster. Instead, this link navigates to Zurich’s commercial website, where you can find a “preferred broker or agent.”

We have no idea (nor does anyone outside Zurich):

When the 73 defunct MPNs became terminated or withdrawn
How many providers are included in each MPN
Which MPNs apply to which Zurich-insured employers
If there is an adequate number of physicians to treat common injuries experienced by the employees restricted to these MPNs

California MPN law also tasks the DWC with ensuring that each MPN secures a separate written acknowledgment in which each physician affirmatively elects to be a member of the MPN.

We have no idea (nor does anyone outside Zurich) if Zurich can actually produce these written acknowledgements from the thousands of providers that must be (or must have been at some point) members of any of the 83 Zurich MPNs.

The table below is copied directly from the DWC’s List of Approved MPNs web page. Note that where the ‘MPN Approval Status’ is blank, the MPN is considered active—an extra dash of confusion courtesy of the DWC.

Take a look at the table, which represents just one insurer, and see if you think minor regulatory tweaks will be sufficient to end the MPN shell game, which hinders injured workers’ access to care and prevents providers from disputing invalid payment denials.

MPN ID#	Name of Applicant	Name of MPN	Date of Approval (yyyy/mm/dd)	Website Address of MPN	MPN Approval Status
3125	American Zurich Insurance Company	CorVel Select MPN	2019/01/25	www.corvel.com
1876	American Zurich Insurance Company	American Zurich Insurance Company/CorVel MPN	2011/08/23	www.corvel.com
1142	American Zurich Insurance Company	Zurich Services Corporation Prudent Buyer	2006/05/05	www.zurichna.com
0840	American Zurich Insurance Company	Zurich Primary MPN	2005/08/02	www.zurichna.com
0211	American Zurich Insurance Company	Zurich Choice MPN	2005/04/18	www.zurichna.com
2449	The Zurich Services Corporation	ZSC Select MPN	2016/03/10	www.zurichna.com
1140	Zurich American Insurance Company	Zurich Services Corporation Prudent Buyer	2006/05/05	www.zurichna.com
0846	Zurich American Insurance Company	Zurich Primary MPN	2005/08/02	www.zurichna.com
0208	Zurich American Insurance Company	Zurich Choice MPN	2005/04/18	www.zurichna.com
0209	Zurich American Insurance Company Of Illinois	Zurich Choice MPN	2005/04/18	www.zurichna.com
2402	American Zurich Insurance Company	American Zurich Insurance Company/GENEX MPN	2015/09/03	www.genexservices.com	T
2256	American Zurich Insurance Company	American Zurich/Gallagher Bassett/First Health MPN	2013/12/30		T
2101	American Zurich Insurance Company	Sedgwick/Harbor 2 MPN	2012/12/27		T
2099	Zurich American Insurance Company	Sedgwick/Harbor MPN	2012/12/27		T
2100	Zurich American Insurance Company	Sedgwick/Harbor 2 MPN	2012/12/27		T
2098	American Zurich Insurance Company	Sedgwick/Harbor MPN	2012/12/24		T
2048	Zurich American Insurance Company	WellComp Medical Provider Network	2012/09/14		T
1947	Zurich American Insurance Company	Patriot Risk Services	2012/05/02		T
1910	American Zurich Insurance Company	TRISTAR MPN	2012/02/14		T
1892	American Zurich Insurance Company	Sedgwick CMS Extended Medical Provider Network	2011/11/29		T
1821	American Zurich Insurance Company	ACM/American Zurich MPN	2011/05/03	http://mpn.acmclaims.com/zurich	T
1822	Zurich American Insurance Company	ACM/American Zurich MPN	2011/05/03	http://mpn.acmclaims.com/zurich	T
1823	Zurich American Insurance Company of Illinois	ACM/Zurich American of Illinois MPN	2011/05/03	http://mpn.acmclaims.com/zurich	T
1748	Zurich American Insurance Company	Zurich GBMCS KOJ MPN	2011/01/12		T
1693	Zurich American Insurance Company	Medex	2010/08/19		T
1682	American Zurich Insurance Company	Broadspire Signature Network MPN	2010/08/18		T
1686	Zurich American Insurance Company	Broadspire Signature Network MPN	2010/08/18		T
1692	Zurich American Insurance Company Of Illinois	Broadspire Signature Network MPN	2010/08/18		T
1541	Zurich American Insurance Company	Intracorp	2009/07/28		T
1526	Zurich American Insurance Company	Roth Staffing Companies MPN	2009/05/08		T
1530	Zurich American Insurance Company	Zurich GBMCS MPN	2009/05/08	www.talispoint.com/cvty/gbmpn	T
1522	American Zurich Insurance Company	First Health CompAmerica Primary HCO Network	2009/05/04		T
1533	Zurich American Insurance Company		2009/04/30	www.genexservices.com	T
1497	Zurich American Insurance Company	Medex	2009/02/25		T
1391	Zurich American Insurance Company	CCMSI/Zurich/First Health Comp America Network	2008/08/19		T
1347	Zurich American Insurance Company	Zurich Kaiser MPN	2008/07/09		T
1395	Zurich American Insurance Company	Zurich/Harrah's Bunch CA MPN	2008/07/01		T
1348	American Zurich Insurance Company	Zurich Kaiser MPN	2008/06/30		T
1349	Zurich American Insurance Company Of Illinois	Zurich Kaiser MPN	2008/06/30		T
1362	Zurich American Insurance Company	First Health CompAmerica Primary Network	2008/05/13		T
1337	American Zurich Insurance Company	American Zurich Ins./The GAP, Inc.	2008/02/05		T
1270	Zurich American Insurance Company	Zurich American/Gallagher Bassett/First Health MPN	2007/01/31	www.talispoint.com/cvty/gbfhmpnselect	T
1241	Zurich American Insurance Company	First Health/Tribune Company MPN	2006/09/25		T
1071	Zurich American Insurance Company	Intracorp-Gates McDonald MPN	2005/09/26		T
0847	Zurich American Insurance Company of Illinois	First Health Comp America Primary HCO Network	2005/08/11		T
0837	American Zurich Insurance Company	First Health CompAmerica Select HCO Network	2005/05/31		T
0834	Zurich American Insurance Company	First Health CompAmerica Select HCO Network	2005/05/31		T
0485	Zurich American Insurance Company	Sedgwick CMS Extended Medical Provider Network	2005/05/23		T
0490	Zurich American Insurance Company	Sedgwick CMS Medical Provider Network	2005/05/07		T
0765	Zurich American Insurance Company	First Health Comp America HCO Select Network	2005/05/05		T
0833	Zurich American Insurance Company	TRISTAR MPN	2005/05/03		T
0377	Zurich American Insurance Company	Broadspire-Concentra Standard MPN	2005/04/26		T
0342	Zurich American Insurance Company	FARA-CVTY	2005/04/21		T
0134	American Zurich Insurance Company	Zurich ESIS MPN	2005/04/19		T
0138	Zurich American Insurance Company	Zurich ESIS MPN	2005/04/18		T
0136	Zurich American Insurance Company of Illinois	Zurich ESIS MPN	2005/04/18		T
0645	Zurich American Insurance Company	Zurich/Ward North America Prudent Buyer Medical Provider Network, accessing Prudent Buyer HCO	2005/03/29		T
0531	Zurich American Insurance Company	Broadspire-First Health CompAmerica Select HCO MPN	2005/03/24		T
0648	Zurich American Insurance Company	Zurich American/Gallagher Bassett/Coventry MPN	2005/03/24	www.talispoint.com/cvty/gbcvtympn	T
0557	Zurich American Insurance Company	MedInsights Medical Provider Network, MPN accessing Prudent Buyer HCO	2005/03/22		T
0434	American Zurich Insurance Company	Broadspire-Concentra Standard MPN	2005/03/21		T
0437	Zurich American Insurance Company of Illinois	Broadspire-Concentra Standard MPN	2005/03/21		T
0124	Zurich American Insurance Company	First Health Comp America Select HCO	2005/03/17		T
0301	Zurich American Insurance Company	CorVel MPN	2005/03/14	www.corvel.com	T
0147	American Zurich Insurance Company	First Health CompAmerica Select HCO Network	2005/03/08		T
0438	American Zurich Insurance Company	TCT CA MPN	2005/03/08	www.mywcinfo.com	T
0140	Zurich American Insurance Company	First Health CompAmerica Select HCO Network	2005/03/08		T
0174	Zurich American Insurance Company	TCT CA MPN	2005/03/08	www.mywcinfo.com	T
0148	Zurich American Insurance Company of Illinois	First Health CompAmerica Select HCO Network	2005/03/08		T
0358	American Zurich Insurance Company	Sedgwick First Health CompAmerica Select HCO Network	2005/03/07		T
0355	Zurich American Insurance Company	Sedgwick First Health Comp America Primary HCO Network	2005/03/07		T
0357	Zurich American Insurance Company	Sedgwick First Health CompAmerica Select HCO Network	2005/03/07		T
0308	Zurich American Insurance Company	Zurich Cambridge MPN	2005/02/16		T
1883	Zurich American Insurance Company	Sedgwick CMS / Harbor MPN - Zurich SUMC	2011/09/07		W
1148	Zurich American Insurance Company Of Illinois	Zurich Services Corporation Prudent Buyer	2006/05/05	www.zurichna.com	W
1055	Zurich American Insurance Company	Mezzo Forte Medical Provider Network	2005/08/05		W
0672	American Zurich Insurance Company	American Zurich Insurance Company, Crawford Select	2005/07/01		W
1005	American Zurich Insurance Company	American Zurich Insurance Company - Crawford Primary	2005/07/01		W
0667	Zurich American Insurance Company	Zurich American Insurance Company, Crawford Select	2005/07/01		W
1006	Zurich American Insurance Company	Zurich American Insurance Company - Crawford Primary	2005/07/01		W
0671	Zurich American Insurance Company of Illinois	Zurich American Insurance Company of IL, Crawford Select	2005/07/01		W
0999	Zurich American Insurance Company of Illinois	Zurich American Insurance Company of IL - Crawford Primary	2005/07/01		W
0356	American Zurich Insurance Company	SRS First Health CompAmerica Primary HCO Network (or "SRS First Health Primary")	2005/03/07		W

daisyBill makes treating injured workers easier, faster, and less costly. Request a free demonstration below.

REQUEST DEMO

0 Reader Comments

There are no comments for this article. Be the first to comment!

How did you like the article ?

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.