California: Liability for Self-Procured Treatment Outside the Medical Provider Network

California: Liability for Self-Procured Treatment Outside the Medical Provider Network

A California WCAB panel recently held that while liens may be disallowed for medical treatment procured outside the defendant's Medical Provider Network, the applicant himself is not personally liable to the lien claimants pursuant to Labor Code § 4605 when he "did not intend" to self-procure medical treatment outside of the MPN. Given that the lien claimants are subject to the exclusive jurisdiction of the WCAB, it would appear that they would not have any avenue with which to recover so long as the applicant "did not intend" to self-procure. 

In this case, the WCAB panel rescinded the WCJ's finding that applicant who sustained an industrial injury to his nose and low back self-procured medical treatment outside of defendant's MPN at his own expense pursuant to Labor Code § 4605, when the WCAB panel found that the WCJ incorrectly concluded that any and all medical treatment obtained outside of a properly noticed MPN is necessarily self-procured by an injured worker at his own expense pursuant to Labor Code § 4605, that the authority to determine if a bill is the injured worker's obligation under Labor Code § 4605 is different from exercising jurisdiction under Labor Code § 4903 to determine a lien against compensation based upon an employer's obligation to provide reasonable medical treatment, that the injured worker is only liable for medical treatment that he intended to self-procure at his own expense pursuant to Labor Code § 4605, and that here, while the record showed that the applicant obtained treatment outside the defendant's MPN, the evidence did not establish that he intended to do so at his own expense under Labor Code § 4605. See Mendez-Correa panel decision.

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