Objection to PTP (California)

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Re: Objection to PTP (California)

Postby vampireinthenight on Tue Sep 18, 2018 8:38 am

I don't understand your distinction between PA and NP. But yes, I would generally agree with you that a physician needs to issue the opinion affecting compensation (terminating compensation? I don't follow you).

However, bulletins and regulations aside, LC 3209.10 allows PA and NP to provide treatment under supervision. That is going to override some bulletin from 2000. Have you read the case cited in the notes below 3209.10? It sounds like the legislature was specifically overriding the AD on the issue of PAs providing treatment. And it looks like it happened in 2001.

I suspect this is so b/c the first 3 days of lost time are not compensable; hence taking someone off work for 3 calendar days is not issuing a report that entitles anyone to "compensation".


OK, but what if it is not the first 3 days of TD? What if it is TTD day numbers 100-102?
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Re: Objection to PTP (California)

Postby jpod on Tue Sep 18, 2018 1:24 pm

Didn't see the note (it didn't come in the google search last week when I didn't have the Labor Code handy).

In looking at the Legislative Digest and the arguments for and against the bill it was focused entirely on the doctors first report of injury, was declarative of existing law, does not affect LC definition of physician (which does not include NPs/PAs) and originally had a sunset clause for 1/1/2006.

The California Academy of Physician Assistants argued clarification was needed b/c injured workers who went to a clinic on the weekends when physicians were not present and employees couldn't get authorized time of work. The statute still requires a physician to make any determination for TD (the last sentence in paragraph (a)). So the statute itself draws a distinction between time of work and TD (must give meaning to every word, phrase etc.).

My concern is I think there are situations in which the PA and supervising physicians live and work in different cities. That is not necessarily an issue unless the supervising physician has never examined the employee. If that is so I do not think the supervising physician's opinions can form the basis to terminate TTD b/c the opinion did not come from the PTP or "a physician" the PTP delegated the Duties of the Treating Physician to.

I am only focused on terminating benefits b/c I can voluntarily pay TTD benefits anytime, not so when terminating benefits. That Bulletin seems to say only the PTP or a physician the PTP delegated that task to, can make or report on etc....

Thanks for your input on this.
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Re: Objection to PTP (California)

Postby vampireinthenight on Wed Sep 19, 2018 10:07 am

I think it is wise to tread carefully when stopping TD payments. The code section is sort of a mess. Yes, I think the MD needs to see the IW at least once in order for any opinions on TD or anything else to be considered substantial evidence. That said, if the PA evaluates and finds MMI or P&S, you might send a warning letter that TD will stop. Unless you are under an order to pay TD, the IW has a burden of supplying medical opinions to support the ongoing TD status.
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Re: Objection to PTP (California)

Postby jpod on Wed Sep 19, 2018 11:52 am

I agree on TTD; I was only addressing your query about why I focused on terminating.

The sunset clause was repealed by AB 2919 in 2004. It is weird that the original bill was declarative of existing law and yet originally had a sunset clause.

I also checked Title 8 CCR 9785 and paragraph (a)(1) [maybe it (1)(a)] was last amended after that AD case referenced in the note below LC 3209.10. That Bulletin cites to 9785 so it is not the case that the AD case overturned the definition of PTP as found in the Duties of the Treating Physician regs.

thanks again...
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