California’s DWC Regulations Get Backing From Office of Administrative Law

The California Division of Workers’ Compensation (DWC) has received approval from the Office of Administrative Law on the first set of regulations implementing SB 899, workers’ compensation reforms passed by the Legislature and signed by Gov. Schwarzenegger last April. The emergency regulations became effective Nov. 1 and will be used by employers or insurers to establish medical provider networks (MPNs).

“MPNs will ease access to treatment for workers,” said DWC Administrative Director Andrea Hoch. “Delays brought on by insurer objections to proposed treatments will be reduced because insurers will be more confident MPN doctors are following appropriate treatment guidelines.”

An MPN is an entity or group of providers set up by an insurer or self-insured employer and approved by DWC’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, and MPNs are required to meet access standards to care for common occupational injuries and work-related illnesses.

Further, the regulations require MPNs to follow all medical treatment guidelines established by the DWC and must allow employees a choice of provider(s) in the network after their first visit. MPNs also must offer an opportunity for second and third opinions if the injured worker disagrees with the diagnosis or treatment offered by the treating physician.

To guarantee injured workers have easy access to treatment, the regulations require MPNs in urban areas to ensure a primary care physician and a hospital for emergency care are located within 30 minutes or 15 miles of each employee’s residence or workplace. Specialists must be within 60 minutes or 30 miles. Alternate standards for rural areas must be approved by the administrative director of DWC on a case-by-case basis.

The regulations provide safeguards for workers injured prior to the establishment of approved MPNs by allowing them to continue to receive treatment from their existing doctor(s) if the worker is scheduled for surgery, or the worker’s condition is acute, serious and chronic, or terminal.

Self-insured employers and insurers may obtain information about the application process to establish an MPN by emailing the Division of Workers’ Compensation at dwc@dir.ca.gov. Properly completed applications will be processed within 60 days.

The DWC now has 120 days to adopt permanent regulations for medical provider networks, a process that includes formal public hearings. The emergency regulations are posted on the Department of Industrial Relations Web site at www.dir.ca.gov. Click on rulemaking in the left navigation bar.