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Chapter 4.5. Division of Workers' Compensation
Subchapter 1. Administrative Director--Administrative Rules
Article 3.6. Independent Medical Review

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§9768.17. Treatment Outside the Medical Provider Network

(a) If the IMR agrees with the diagnosis, diagnostic service or medical treatment prescribed by the treating physician, the covered employee shall continue to receive medical treatment from physicians within the MPN.

(b) If the IMR does not agree with the disputed diagnosis, diagnostic service or medical treatment prescribed by the treating physician, the covered employee shall seek medical treatment with a physician of his or her choice either within or outside the MPN. If the employee chooses to receive medical treatment with a physician outside the MPN, the treatment is limited to the treatment recommended by the IMR or the diagnostic service recommended by the IMR.

(c) The medical treatment shall be consistent with the medical treatment utilization schedule established pursuant to Labor Code section 5307.27 or, prior to the adoption of this schedule, the ACOEM guidelines. For injuries not covered by the medical treatment utilization schedule or by the ACOEM guidelines, the treatment rendered shall be in accordance with other evidence-based medical treatment guidelines which are generally recognized by the national medical community and scientifically based.

(d) The employer or insurer shall be liable for the cost of any approved medical treatment in accordance with Labor Code section 5307.1 or 5307.11.

NOTE

Authority cited: Sections 133 and 4616, Labor Code. Reference: Sections 4616.4, 5307.1, 5307.11 and 5307.27, Labor Code.

HISTORY

1. New section filed 12-31-2004 as an emergency; operative 1-1-2005 (Register 2004, No. 53). A Certificate of Compliance must be transmitted to OAL by 5-2-2005 or emergency language will be repealed by operation of law on the following day.

2. Certificate of Compliance as to 12-31-2004 order, including amendment of Note, transmitted to OAL 4-29-2005 and filed 6-10-2005 (Register 2005, No. 23).

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