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Division of Workers' Compensation - Medical provider networks

A medical provider network (MPN) is an entity or group of health care providers set up by an insurer or self-insured employer and approved by DWC's administrative director to treat workers injured on the job. Under state regulations, each MPN must include a mix of doctors specializing in work-related injuries and doctors with expertise in general areas of medicine. MPNs are required to meet access to care standards for common occupational injuries and work-related illnesses. The regulations also require MPNs to follow all medical treatment guidelines established by the DWC and allow employees a choice of provider(s) in the network after their first visit. Additionally, MPNs must offer an opportunity for second and third opinions if the injured worker disagrees with the diagnosis or treatment offered by the treating physician. If a disagreement still exists after the second and third opinion, an injured worker in the MPN may request an independent medical review (IMR). The MPN program became effective Jan. 1, 2005 and employees can be covered by an MPN once a plan has been approved by the DWC administrative director.

Who has an MPN?
  • update image Current list of approved medical provider networks by approval date ** PLEASE DESCRIBE THIS IMAGE ** version
  • update image Current list of approved medical provider networks by name of applicant acrobat image version
MPN rules
MPN forms

Medical provider network forms

  • Cover page for medical provider network application fillable image version
  • Notice of medical provider network plan modification section 9767.8 effective Oct. 8, 2010 fillable image version
  • Notice of medical provider network plan modification section 9767.8 fillable image version
  • Independent medical review application (for injured workers who need to get an independent medical review) fillable image version
  • Solicitud de Revisión Médica Independiente fillable image version
MPN notices
  • Sample initial written employee notification re: Medical provider network word image version acrobat image version
  • Información Importante sobre Cuidado Médico si tiene una Lesión o Enfermedad de Trabajo word image version acrobat image version
  • Sample MPN implementation, termination/cessation of use, and change of MPN notices acrobat image version
MPN information

Memo to health care providers interested in joining an MPN acrobat image version

News and other info
Aug. 10, 2010 Division of Workers’ Compensation’s amended medical provider network and employee information regulations approved by Office of Administrative Law
Amendments become effective Oct. 8, 2010 acrobat image version

June 2011