Predesignation of a Personal Physician - Reviewed

Saturday, September 24, 2005 | 0

The Administrative Director has submitted emergency regulations for Predesignation of a Personal Physician to the Office of Administrative Law for approval. The OAL has ten days to respond to the request for approval but may approve the regulations in advance of that time. Once approved the regulations are effective for a period of 120 days after which the Administrative Director may reissue the rules (one time) or adopt final rules after public hearing and comment.

These rules are certain to generate controversy as they answer many questions regarding not only predesignation but other issues of interest regarding receipt of medical care and selection of treating physicians. Among other issues addressed by these regulations are the following items:

1. A predesignated personal physician must agree to be pre-designated prior to an injury but not necessarily on the predesignated form. [ADR 9780.1(a)(3)] This is significant as several employee representative groups have argued that a physician may agree to be predesignated subsequent to an industrial injury.

2. The employer's provision of group health insurance is sufficient to allow predesignation regardless of whether the employee accepts or participates in the group health plan or not. [ADR 9780.1(a)(2)] Considerable speculation has occurred over whether an employee actually had to participate in the group health benefit in order to predesignate a personal physician.

3. Where an employee has validly predesignated a personal physician, the employee is not in the MPN for any reason and the personal physician cannot be required to refer to physicians or facilities within the MPN.[ADR 9780.1(d) &(e)].

4. The employer may not, without consent of the injured worker, contact the predesignated personal physician to confirm the consent to be predesginated. [ADR 9780.1(f)]

5. The request for a change of treating physician by an employee pursuant to Labor Code section 4601 does not apply to any employee whose employer had a MPN. [ADR 9781(a)] One of the tactics that has been suggested by applicant attorneys to get their employees out of MPNs was to demand a change of treating physician pursuant to Labor Code