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Don't Lose Medical Control: Regulation 9787 is More Important Than Ever!
by Christopher P. Stettler, Esq.
 Now that many insurers and employers have implemented Medical Panel Networks (MPNs), is it still necessary to advise the primary treating physician (PTP) of California's reporting requirements? (See Title Eight, California Code of Regulations §9785.)
Absolutely!
An administrator who offers an MPN in not entitled to file a Petition for Change of Treating Physician, as set forth in Section 9786, if a covered employee is treating with an MPN physician. However, we are seeing more and more Petitions for Change of Treating Physician being filed by applicant attorneys in order to to gain medical control. Therefore, it is imperative that the MPN physician receives, understands, and follows the reporting requirements outlined in Section 9785. It is essential to remind the PTP that a report must issue at least every 45 days during active treatment, in the form and manner prescribed by the Administrative Director. If the MPN physicians are not reporting in a timely manner, we risk losing medical control.
Bradford & Barthel, LLP, recommends that a copy of Section 9785 regulations regarding reporting duties be sent to the designated MPN PTP. We also recommend the physician be advised of his duty to report at least every 45 days during active treatment, and that the reports be submitted on the "Primary Treating Physician's Progress Report" form (PR-2) or in the form of a narrative report.
If the narrative form is used, it must:
- Be entitled Primary Treating Physician's Progress Report in bold-face type.
- Clearly indicate the reason the report is being submitted.
- Contain the same information and subject headings as are found in the PR-2 form.
Again we are seeing increasing numbers of Petitions for Change of PTP filed by applicant attorneys because the treating physician is not using the PR-2 form, is using an improper narrative form, and/or is not reporting timely. This must be avoided
As defendants, we have spent too much time and effort to lose medical control due to sloppy PTP reporting. Keep your MPN treating doctors updated as to the reporting requirements of Section 9785. Provide them a copy of the relevant regulation -- frequently! Take these necessary precautions, and you will dramatically decrease the chances that applicant will escape your MPN's control. Follow these simple rules and protect your investment!
Christopher P. Stettler is a Partner and Managing Attorney of Bradford & Barthel's San Diego Office.
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This web site seeks to provide accurate, informative updates pertaining to items of interest to Bradford & Barthel, LLP's clients and friends. It is not intended to render legal advice. If legal advice or expert analysis is needed, seek an attorney's assistance. All opinions expressed in this newsletter are those of the authors and not necessarily endorsed by Bradford & Barthel, LLP, its partners, attorneys, employees or agents.
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