Treatment outside MPN and expedited hearing (California)

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Re: Treatment outside MPN and expedited hearing (California)

Postby spreare on Thu Oct 15, 2009 7:28 am

davidd, that is exactly my point!I then why the coercive denial of ttd!!! bet I can't get anyone on the defense side to answer that here..
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Re: Treatment outside MPN and expedited hearing (California)

Postby on Sat Oct 17, 2009 8:15 am


I have to take issue with your post on the 4605 cases. Both cases did hold that the applicant can obtain Tx outside the MPN without the defendant paying for it.

However neither case addressed the issue of admissability of the reports of the applicant's physician. That issue is as yet unresolved.
LC 4605 does not label such a physician as a "treating physician" but as either a "consulting physician" or an "attending physician". I am not certain how the court will interpret the difference. It is my contention only the designated physician within the MPN is entitled to be considered as the primary treating physician and reports of 4605 consulting or attending physicians are not admissable.

As far as notice into the MPN is concerned, the real issue is usually not whether the proper notices were given, overwhelmingly they are. The problem is almost always a proof issue as documenting the service of the notices is frequently overlooked when the matter comes up before the WCAB. In my experience most employers, with the initiation of the MPN go to great lengths to make certain proper notice is given. the MPN plan will not be approved unless it provides for inital notice including the content of the notices that complies with the statutory requirements. Defendants are frequently met with applciants who simply testify they do not recall receiving the notices and need to be prepared to prove that service was accomplished.

In such cases it is also critical that defendants be aware the medical Treatment expense is a lien on PD and it cannot agree to pay, adjust or litigate the medical treatment bill holding applicant harmless counting on the ability to deny the bill based on these cases. If there is no fund to pay the bill that is withheld from the PD award, it will become defendant's liability as they will have held applicant harmless on the lien.
Jake Jacobsmeyer
Shaw, Jacobsmeyer, Crain & Claffey
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Re: Treatment outside MPN and expedited hearing (California)

Postby chirple on Sun Oct 18, 2009 9:02 am

It could be the "coercive" denial of TTD is simply that the adjuster doesn't know any better or the adjuster wants to force an EH so as to enforce the MPN.

I would caution that even if the non-MPN reports are not admissable, a med-legal will likley be the next step. This med-legal physician will be reviewing medical records, and will quite probably find that the IW was TTD based on those records, which include the non-MPN physician.

So, yeah, deny the non-MPN physician's bills, pay the TTD based on them, but get the med-legal ball rolling.

The problem I see, is a/a's stating that because the defense will not recognize the non-MPN physician as the PTP, they have no standing to object to his reports and get the med-legal process started. To which I call a big BS. Either he is the PTP or not. You can't have it both ways. But, then you have to fight with the medical unit for the panel.
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