Where this sits
- Chapter 4.5.
- Division of Workers' Compensation
- Subchapter 1. Administrative Director--Administrative Rules
- Article 3.5. Medical Provider Networks
The regulation, as printed
(a) When an injury is reported or an employer has knowledge of an injury that is subject to an MPN or when an employee with an existing injury is required to transfer treatment to an MPN, a complete written MPN employee notification with the information specified in paragraph (2) of this subdivision, shall be provided to the covered employee by the employer or the insurer for the employer. This MPN notification shall be provided to employees in English and also in Spanish if the employee primarily speaks Spanish. (1) A complete MPN notification with the information specified in paragraph (2) of this subdivision may be sent electronically in lieu of by mail, if the covered employee has regular electronic access to email at work to receive this notice at the time of injury or when the employee is being transferred into the MPN. If the employee cannot receive this notice electronically at work, then the employer shall ensure this information is provided to the employee in writing at the time of injury or when the employee is being transferred into the MPN. (2) The complete written MPN employee notification shall include the following information: (A) The unique MPN Identification number. How to contact the person designated by MPN applicant to be the MPN Contact for covered employees to answer questions about the use of MPNs and to address MPN complaints. The employer or insurer shall provide a toll-free telephone number with access to the MPN Contact if the MPN geographic service area includes more than one area code. A toll-free number must also be listed for MPN Medical Access Assistants, with a description of the access assistance they provide, including finding available MPN physicians of the injured workers' choice and scheduling and confirming physician appointments, and the times they are available to assist workers with obtaining access to medical treatment under the MPN; (B) A description of MPN services as well as the MPN's web address for more information about the MPN and the web address that includes a roster of all treating physicians in the MPN; (C) How to review, receive or access the MPN provider directory. An employer, insurer, or entity that provides physician network services shall ensure covered employees have access to, at minimum, a regional area listing of MPN providers in addition to maintaining and making available its complete provider directory listing in writing and/or on the MPN's website. The MPN's website address shall be clearly listed. If an employee requests an electronic provider directory listing, it shall be provided electronically on a CD, flash drive, via email or on a website. The URL address for the provider directory shall be listed with any additional information needed to access the directory online including any necessary instructions and passcodes. MPN applicants are responsible for updating an MPN's provider listings, at minimum, on a quarterly basis with the date of the last update provided on the listing given to the employee. Each provider directory listing shall include a phone number and an email address for reporting of provider listing inaccuracies. If a listed provider becomes deceased or is no longer treating workers' compensation patients at the listed address, the provider shall be taken off the provider directory within 45 days of notice to the MPN through the contact method stated on the provider directory listing to report inaccuracies. (D) How to access initial care and subsequent medical care and how to contact the medical access assistants if an employee needs help in finding a physician or scheduling an appointment; (E) The mileage, time requirements and alternative access standards required under section 9767.5; (F) How to access treatment if (A) the employee is authorized by the employer to temporarily work or travel for work outside the MPN's geographic service area; (B) a former employee whose employer has ongoing workers' compensation obligations permanently resides outside the MPN geographic service area; and (C) an injured employee decides to temporarily reside outside the MPN geographic service area during recovery; (G) How to choose a physician within the MPN; (H) What to do if a covered employee has trouble getting an appointment with a provider within the MPN and how to use the medical access assistants for help; (I) How to change a physician within the MPN; (J) How to obtain a referral to a specialist within the MPN or outside the MPN, if needed; (K) How to use the second and third opinion process; (L) How to request and receive an MPN independent medical review; (M) A description of the standards for the transfer of care policy and a notification that a copy of the policy in English or in Spanish if the employee speaks Spanish shall be provided to an employee upon request; and (N) A description of the standards for the continuity of care policy and a notification that a copy of the policy in English or in Spanish if the employee speaks Spanish shall be provided to an employee upon request.
What panels did with this rule
Released decisions that named § 9767.12, with the passage each turned on. A panel decision persuades; it does not bind.
- ADJ15329380 · 2025-10-31 · Anaheim District Office8 CCR § 9767.12
Determinative passage · p.6(Lab. Code, § 5811(b)(2).) Here, defendant contends that the medical treatment given by Dr. Russman, during which time the disputed interpreting services were used, was not reasonable and necessary because applicant improperly treated outside the defendant's MPN, and, as a result, lien claimant's services are similarly unreasonable, unnecessary, and non-recoverable. (Petition, p. 2.) As parties are well aware, it is defendant's burden to establish the existence of the MPN, and that written notification of the MPN, and all other requisite information under AD Rule 9767.12, was provided to applicant, both before and after the subject injury. (Cal. Code Regs., tit. 8, § 9767.12.) Treatment through the MPN must also be accessible, not neglectful, and actually available to applicant. (See Cal. Code Regs., tit. 8, § 9767.5; Lab. Code, § 4600(a); see also McCoy v. I.A.C. (1966) 64 Cal.2d 82, 87 [31 Cal.Comp.Cases 93] ["the employer is required to provide treatment which is reasonably necessary to cure or relieve the employee's distress, and if he neglects or refuses to do so, he must reimburse the employee for his expenses in obtaining such treatment"].) Although notice of the MPN was apparently given to applicant after the injury (Defense Exhibit C), defendant failed to produce evidence that Dr. Greene was in fact listed within the MPN and provided actual treatment to applicant.
Applied to determine whether applicant improperly treated outside the MPN.
Official decision · page 6 → - ADJ15777619 · 2025-10-13 · Anaheim District Office8 CCR § 9767.12
Determinative passage · p.6Defendant contends that applicant has not met her burden to establish neglect or a refusal to provide treatment. This burden however is misplaced, it is the defendant's burden to establish the existence of the MPN, that defendant provided the required Notices of the MPN, 8 Cal. Code of Regs. § 9767.12, both prior to the injury and subsequent to the injury, and that treatment was provided and not neglected. In order to meet this burden, the defendant must submit evidence of its MPN, the notices provided and the treatment offered. The defendant did not submit any evidence, either documentary or through testimony, to meet its burden. As set forth in the Opinion on Decision, the court addressed Knight v. United Parcel Service (2006) 71 Cal.Comp.Cas. 1423 as well as Senate Bill 863 which resulted in Labor Code § 4616.3(b)1 being implemented. In its analysis, the court held as follows:
Applied to find defendant failed to meet burden of proof, resulting in denial of reconsideration and allowance for applicant to treat outside MPN.
Official decision · page 6 → - ADJ13323913 · 2024-12-16 · Los Angeles District Office8 CCR § 9767.12
Determinative passage · p.6AD Rule 9767.12 provides for notification of the MPN as follows: (a) When an injury is reported or an employer has knowledge of an injury that is subject to an MPN or when an employee with an existing injury is required to transfer treatment to an MPN, a complete written MPN employee notification with the information specified in paragraph (2) of this subdivision, shall be provided to the covered employee by the employer or the insurer for the employer. This MPN notification shall be provided to employees in English and also in Spanish if the employee primarily speaks Spanish.
Defendant's April 9, 2020 letter failed to meet notification requirements, contributing to liability for treatment costs.
Official decision · page 6 → - ADJ808475 · 2023-08-25 · Van Nuys District Office8 CCR § 9767.12
Determinative passage · p.2The injured employee may be transferred into the MPN for medical treatment unless certain exceptions apply. (Cal. Code Regs., tit. 8, § 9767.9(a).) One exception allows an additional year of treatment outside the MPN when the injured employee has a serious chronic condition. (Cal. Code Regs., tit. 8, § 9767.9(e)(2).) Applicant was provided with an additional year of treatment outside of the MPN due to his serious chronic condition. (Report, pp. 3-4.)
Defendant followed the required steps for transfer to MPN, and applicant received proper notice and additional time for treatment outside the MPN due to a serious chronic condition.
Official decision · page 2 →
Rules beside this one
Article 3.5. Medical Provider Networks — regulations rarely stand alone, and the answer is often two sections away.
- § 9767.1Medical Provider Networks -- Definitions.1 decisions
- § 9767.10Continuity of Care Policy.1 decisions
- § 9767.11Economic Profiling Policy
- § 9767.13Denial of Approval of Application or Reapproval; Re-Evaluation.
- § 9767.14Probation, Suspension or Revocation of Medical Provider Network Plan; Hearing.
- § 9767.15Compliance with Current MPN Regulations; Reapproval.