In the case of Gregory Parrent v. WCAB, 2017 Cal.Wrk.Comp, Lexis 3, Mr. Lopez defended a claim, representing Pacific Bell and Sedgwick. In this matter, the worker, Gregory Parrent was seeking to have the WCAB consider the medial treatment recommendations made by a medial provider network. The WCAB found that the dispute, if any, must proceed through Utilization Review/Independent Medical Review process (IMR) pursuant to Labor Code, Section 460, 4610.5 and 4610.6. Which had been done.
The WCAB reasoned that treatment recommendations of the medial provider networking physician, if disputed by the employer, must be reviewed thr UR/IIMR, and that to conclude otherwise would deny the employer the right to obtain review of a challeged recommendations through the proceedures expressily designed to advance the legislative goal of ensuring that injured workers are provied medical treatment consistent with uniform “evidence based, peer-reviewed, nationally recognized standards of care”.
The Court of Appeal further noted, that if an injured worker has a dispute concerning diagnosis or treatment recommendations by a medical provider physician, the MPN provides a mechanism for the worker to obtain second and third opinions from other medical provider network physicians, and if necessary, to submit the dispute to an MPN/IMR.
The WCAB determined that the medical provier network dispute process in Labor Code, Section 4616, is not available to an employer and the only available method for the employer to dispute treatment recommendations is through UR/IMR. As such, the employer/carrier argued and prevailed on the argument that, as the employer complied with UR and IMR, the WCAB did not have jurisdiction to determine the medical necessity of the treatment recommended in this case.