When a California employee sustains a work-related injury, and the employer maintains a Medical Provider Network (MPN), it is the employer’s legal responsibility to (within one day) arrange and pay for the initial evaluation with an MPN doctor.

California law requires the Division of Workers’ Compensation (DWC) to provide injured workers a clear and concise explanation of this benefit. According to this law the Workers’ Compensation Claim Form (DWC 1) should provide “easily understandable” instructions to injured workers on managing their work injury.

The law demands this form include “From whom the employee can obtain medical care for the injury.”

However, the DWC 1 provides muddled and imprecise instructions that arguably deprive injured workers of critical information about the employer’s responsibility to immediately provide care for a reported injury.

The information offered by the DWC makes it virtually impossible for employees to navigate an already confusing workers’ comp system — a system made even more unnavigable by MPNs.

Below, we precisely outline a newly injured worker’s rights within the first day of reporting an injury where the employer or insurer maintains a restrictive MPN, and how the DWC fails to communicate those rights to California injured workers.

CA MPN Law - Initial Treatment / Evaluation

When an employee reports an injury to an employer that maintains an MPN, the employer must arrange an initial medical evaluation visit with an MPN doctor. According to Labor Code Section 4616.3 (emphasis ours):

“(a) If the injured employee notifies the employer of the injury or files a claim for workers’ compensation with the employer, the employer shall arrange an initial medical evaluation and begin treatment as required by Section 4600.”

California regulations support and expand on these employer responsibilities, mandating that the employer or insurer arrange an initial medical evaluation within one working day with an MPN physician. California Code of Regulations Section 9767.6 states (emphases ours):

“(a) When the injured covered employee notifies the employer or insured employer of the injury or files a claim for workers' compensation with the employer or insured employer, the employer or insurer or entity that provides physician network services shall arrange an initial medical evaluation with a MPN physician in compliance with the access standards set forth in section 9767.5.”

This benefit is sensible and simple. Unfortunately, newly injured workers may not be aware of it, due to incomplete and even contradictory instructions the DWC provides injured workers.

DWC 1 Form Fails Injured Workers

Labor Code Section 5401 assigns the DWC Administrative Director (currently George Parisotto) the responsibility of implementing an “easily understandable” claim form that an employee files with their employer to report an injury, and that explains the “potential eligibility for benefits” per California workers’ compensation laws.

To assist injured workers in navigating their injury, the legislature mandated that the Administrative Director include the following information on the claims form the injured employee files with their employer

“(4) From whom the employee can obtain medical care for the injury”

To adhere to this legal mandate, the Administrative Director developed the DWC 1 form that injured workers must file with their employers to report the injury. Per the legislative requirement, the reverse side of the form includes a “Notice of Potential Eligibility.”

However, Form DWC 1 fails to explain to the injured worker that the employer or insurer is responsible for arranging and paying for the first visit with an MPN physician.

Regarding MPNs, Form DWC 1 states the following:

“If your employer is using a medical provider network (MPN) or Health Care Organization (HCO), in most cases, you will be treated in the MPN or HCO unless you predesignated your personal physician or a medical group. An MPN is a group of health care providers who provide treatment to workers injured on the job. You should receive information from your employer if you are covered by an HCO or a MPN. Contact your employer for more information.”

Astoundingly, the DWC 1 form neglects to instruct the injured worker that the employer or insurer must make arrangements for the injured worker’s initial treatment. Without this essential information, an injured worker cannot know “From whom the employee can obtain medical care for the injury” as required by California law.

Injured CA Workers: Stranded Without Information

It is inarguable that requiring employers to arrange and pay for the first doctor visit (even before the employer has accepted liability for the injury) is theoretically an essential benefit — and immense relief — to an injured worker. Thus the reasoning behind the legislative mandate that the DWC explain this benefit to injured workers.

However, the DWC fails injured workers by not alerting them to this important benefit. Like so many of the unannounced or unenforced requirements designed to help injured workers, the laws and regulations regarding the first visit to an MPN doctor are useless unless they’re executed in the real world.

Anyone who’s been injured at work knows how intimidating and confusing it is to seek prompt, quality care. California law attempts to help injured workers know their legal rights. But rather than comply with the intent of the law, the DWC offers half-baked instructions that fail to help California employees navigate the claims process.

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