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The WCAB reconsidered an order regarding applicant's treatment outside the employer's Medical Provider Network (MPN). Applicant sought to continue treatment with a physician not in the MPN after the claim was initially denied and later accepted. The Board amended the prior order to clarify that applicant was "improperly" treating outside the MPN, finding that Labor Code section 4603.2(a)(2) does not apply when the employer exercises medical control after accepting the claim, absent a prior final determination of entitlement to an outside physician. One commissioner dissented, arguing the case should be remanded to determine if the employer's significant delays in accepting the claim constituted a failure to provide medical care, which would allow continued treatment outside the MPN.
Full Decision Text1 Pages
The WCAB reconsidered an order regarding applicant's treatment outside the employer's Medical Provider Network (MPN). Applicant sought to continue treatment with a physician not in the MPN after the claim was initially denied and later accepted. The Board amended the prior order to clarify that applicant was "improperly" treating outside the MPN, finding that Labor Code section 4603.2(a)(2) does not apply when the employer exercises medical control after accepting the claim, absent a prior final determination of entitlement to an outside physician. One commissioner dissented, arguing the case should be remanded to determine if the employer's significant delays in accepting the claim constituted a failure to provide medical care, which would allow continued treatment outside the MPN.
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