Treatment Referrals: Who Can Make Them?
In the recent case of Terry Scudder v. Verizon (ADJ916063, March 11, 2011), the WCAB held that medical reports issued by physicians outside the Defendant’s MPN and outside the Applicant’s pre-designated physician were inadmissible.
In this case, the employer had a valid MPN but Applicant pre-designated a doctor as his treating physician prior to his injury. Pursuant to CCR 9780.1(c), Applicant had the right to treat with his pre-designated physician outside the MPN. This pre-designated physician, pursuant to CCR 9780.1(d), has the right to make any referral to another physician for treatment. That referral treatment does not need to be within the MPN.
It was concluded however that CCR 9780.1(d) allowed only the pre-designated physician to make the referrals outside the MPN. The Applicant and the Applicant’s attorney do not have the right to select treatment outside the MPN. In this case, it was Applicant’s attorney who elicited the services of two additional physicians. The reporting of those additional physicians was deemed inadmissible since their services were not at the request of the pre-designated treating physician. As such,the referrals were not valid under section 4600(d)(6) and thus were inadmissible.
Applicant’s attorney argued that CCR 9780.1(d) can be read to allow any referral to another physician outside the MPN, including a referral by applicant’s attorney. However, the WCAB disagreed as this interpretation would contravene the statutory language of section 4600(d)(6). Since the Defendant had an MPN, Applicant had no right under LC 4600(c) to change his treatment from the prior treating physician pre-designated under LC 4600(d) to a physician outside MPN more than 30 days after he reported his injury. Even though Applicant is entitled to medically appropriate referrals outside MPN by his pre-designated physician, a referral to a physician designated by Applicant’s attorney is not appropriate under LC 4600(d). As such, doctors appointed by Applicant’s attorney are not treating physicians pursuant to LC 4061, 4062 and 4062.2 and thus their reports are inadmissible.