Managing Employee Injuries and Disability and Occupational Safety

provide a notice to the employee advising him of his right to a change of physician following the expiration of the 30 day period.

The employee who is being treated by a physician he has selected may lose the right to control his medical treatment. This may arise because his selected physician is not complying with various reporting requirements, including an obligation to provide periodic evaluations to the employer or insurance carrier concerning the employee’s condition and the course of treatment. The employer may also attempt to regain control of medical treatment if the treatment being provided by the employee-designated physician is unreasonable, unnecessary or excessive. In order to regain control of medical treatment, the employer may be required to file a petition with the Medical Director of the Division of Workers’ Compensation and show good cause for the change of physician. It should be noted that the employer or insurance carrier could also refuse to pay further medical bills to the employee designated physician on grounds that the treatment was not reasonable or necessary. 4. C ONTROL OF M EDICAL T REATMENT – A FTER J ANUARY 1, 2005 Employers are allowed to contract with “networks” of doctors. Employers who do so maintain medical control indefinitely. Employees are allowed to change doctors within the network, after the first visit, which is with a doctor selected by the employer. The Administrative Director is required to promulgate regulations setting standards for networks pertaining to: (1) geography; (2) number of, and access to, specialists; (3) timelines for access to treaters and specialists. The bill specifies the percentage of physicians within the network who must be primarily non- occupational, and requires that the employer provide for continuity of care. In order for a worker to get treatment, which is denied by his original treater, or to get out of the network, the employee must see two additional doctors within the network. If both of those physicians deny the request to get out of the network, then the employee is eligible for review by an Independent Medical Reviewer (IMR), paid for by the employer. The employer loses medical control if IMR sides with injured worker, but maintains control (and denial of treatment is binding) if the IMR sides with the employer. The IMR determination is not subject to review. LC 4616 et seq. An employer or insurance company must notify each employee in writing about the network 30 days prior to implementation of the network, 8 Cal. Code of Regs. Rule 9767.12, and must provide 30 days notice in writing to each employee of any changes in the network, Labor Code 4616.2. The notices must be in English and Spanish.

An employer may require an employee to seek treatment within the network regardless of date of injury. 37

All disputes, including if the injured worker needs a medical-legal evaluation to prove a denied injury, will go to panel QME’s. The Administrative Director must send the party declaring a dispute a panel of three QME’s to pick from within 15 days. The provision is modeled after labor arbitration, with each party rejecting one QME, the injured worker to see the remaining QME.

Managing Employee Injuries, Disability and Occupational Safety ©2019 (s) Liebert Cassidy Whitmore 32