Don Dressler Consulting

The State Compensation Insurance Fund is terminating one of the three components of its medical system, the “State Fund Preferred Provider Network (PPN) as of April 30, 2006. The State Fund still has agreements with Blue Cross of California and its Medical Provider Network as well as the occupational health services of Kaiser Permanente.

The PPN network began several year ago, as a way for State Fund to negotiate lower medical fees for workers’ compensation services. Prior to the 2004 workers’ compensation reforms, employers who agreed to use the PPN or Kaiser programs for referrals and an active “return to work” program, could obtain a 10% reduction in their workers’ compensation premiums.

With the advent of Medical Provider Networks in the 2004 reforms, and “life of claim” medical control if the procedures are correctly followed, State Fund added the Blue Cross Medical Provider Network, and revised its rating to eliminate the credit for use of the medical program.

Important steps for employers to take:

Make sure you refer your injured workers to a physician in the Blue Cross or Kaiser Permanente program now. Do not wait until April 30, 2006, since you do not want to get caught up in a problem of shifting care from one physician to another.
Get new MPN notices from State Fund, since the old notices refer to PPN, and will need to be replaced. These notices need to be given to every newly hired employee and to every employee at time of injury. (Best practice is to attach a copy of the MPN notice to the DWC 1 claim form.)
Make sure that you have posted the required Workers’ Compensation posters and give new employees the required pamphlets. A recent WCAB ruling allowed an injured worker to seek any doctor he wanted, ignoring employer medical control, because the employer could not prove it had posted the required notices.

If you have questions about Medical Provider Networks, what notices you are required to provide your employees, or how to lower your workers’ compensation costs, call Don Dressler at 949-533-3742 or e-mail: DonDressler1@hotmail.com.