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THE MEDICAL PROVIDER NETWORK HAS ARRIVED: Some important information about the MPN and how it impacts Washington State workers' compensation claims

Posted by Foster Law on January 31, 2013

Is your medical provider in network?

Lately the number one question on the minds of Washington State's injured workers, their attorneys, and their medical providers seems to be, is your doctor in network? This is because effective January 1, 2013, injured workers may only treat with providers who are in the Department of Labor and Industries' new Medical Provider Network (MPN).

What is the MPN?

The Medical Provider Network is a group of medical providers who the Department has approved to provide medical treatment to injured workers in our state. In order to continue treating their injured worker patients after January 1, 2013, physicians, dentists, chiropractors, advanced registered nurse practitioners, naturopathic physicians, optometrists, podiatric physicians and surgeons, and physicians assistants are required to apply and be accepted in the new MPN. For injured workers, if your provider is not in the network, the Department or self-insured employer may not pay your treatment expenses.

However, at this time, there are some important exceptions to note:

  1. An initial office or emergency room visit when the accident report for the workers' compensation claim is filed will be paid even if the medical provider is not in the MPN. However, for all follow-up care, the injured worker must treat with a provider who is in the MPN.
  2. Physical therapists, occupational therapists, massage therapists, and out-of-state providers are not currently required to join the MPN in order to be compensated for medical services.
  3. Because the Department has not yet completed processing all of the provider applications for the MPN, injured workers who are treating with a provider whose application is still being processed may continue to treat with that provider for work-related injuries and/or conditions while the Department completes its review of the provider's application.

How do you find out if your provider is a member of the MPN?

The Department has developed a search tool to assist injured workers in determining the status of their medical provider's MPN application and to find providers who are already in the MPN. Simply visit the Department's website at: http://www.lni.wa.gov/ClaimsIns/Claims/FindaDoc/

How will the MPN impact industrial insurance medical coverage for injured workers?

There is little question that the MPN and the anticipated occupational health education that will accompany it will change the landscape of industrial insurance medical coverage for injured workers. With the creation of the MPN, the Department anticipates a cycle of continuing health care improvement as providers who have joined the MPN will be presented with both financial and non-financial incentives encouraging them to follow the Department's guidelines for occupational health best practices in order to achieve “top tier” provider status. However, it is important to note that the Department will also have profound opportunity to dictate the type of care an injured worker receives and from whom. In a system where injured workers already face difficulty obtaining medical providers willing to take on the complications that a workers' compensation claim entails, the MPN could present increased difficulty. Medical providers may be faced with the dilemma of deciding whether adherence to the Department's guidelines for occupational health best practices interferes with the provider's own best judgment and practices. Medical providers that reject the Department's notion of best practices will likely discontinue treating injured workers.

Simply put, it is difficult to assess the long term impact the MPN is going to have on injured workers in the Washington State. Certain aspects of the new legislation may assist injured workers to receive better medical treatment and a speedier return to gainful employment. Other aspects of the new system may have a chilling effect on certain providers and treatment modalities which do not fit within the Department's notion of occupational health best practices.

At Foster Law, P.C. we are expert, we are fierce, and we are compassionate. Our team offers decades of experience to helping literally thousands of injured workers obtain the benefits that are so crucial to maintaining their welfare and that of their families. If you are an injured worker or medical provider and have questions or concerns about the MPN or any other aspect of workers' compensation law in this state, we invite you to contact us. Initial consultations are complimentary.  Don't leave your workers' compensation claim to chance; consult with experts.

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