If a physician who meets these requirements is not available, the employee may be authorized to process outside of the NPP.16 A physician outside of the NPP must still follow workers` compensation processing procedures, including treatment claims through the review of use and acceptance of payments through the workers` compensation insurance institution. When the injured employee notifies an employer of an injury, the employer arranges the first visit to the doctor.12 The MPN and the use review work together to guide the medical treatment of an injured employee. The MPN takes care of who will treat an injured worker, while the UR takes care of the treatment that the injured worker can receive. The attending physician directs the medical care of an injured worker. The physician determines the injured worker`s ability to work during the injury and the periods of temporary disability that the injured worker should receive. The attending physician will also issue an opinion on when the injured worker`s condition stabilized and the level of permanent disability he or she suffered. If the employee is killed at work, there is no problem with MPN as no medical treatment is offered. The case is considered a death. Example: Erica is hit in the head and injured while working on a construction site. She suffers from a concussion. Erica tries to choose a neurologist from the MPN list to treat her.

But she can`t find one within 30 miles of her work or home. Erica can be treated by a doctor outside of the MPN. Example: Joanne injures her right arm while working. She has pain in her right elbow, but does not think that her doctor will provide her with the right treatment. If the second or third assessor makes a decision in favour of the injured employee, the injured employee may change the attending physician to the second or third opinion physician or physician in the MPN.24 An important factor Erica should consider is whether the neurologist she chooses is willing to see her. Many physicians may not want to take care of an injured worker because they must follow employee compensation procedures. Networks of medical care providers are an attempt by insurance companies to control the cost of medical care in the workers` compensation system. Insurance companies may try to exclude certain doctors from their network because they believe the doctor needs excessive medical treatment or gives too much permanent disability. For this reason alone, it is in the interest of every injured worker to change doctors within the MPN after the first visit in order to receive fair treatment and compensation. If the injured worker requires treatment from a specialist who is not in the MPN, treatment outside the MPN is determined on a case-by-case basis.17 A specialist`s recommendation comes from the attending physician.

After the first visit to the doctor after an injury, the injured worker can select any doctor within the network of medical providers. Example: Andrea injures her back while working. She is sent by her employer to an emergency clinic. A second visit is planned. Andrea is not very satisfied with the treatment she receives at the industrial clinic. After the first visit, the employer is required to inform the injured employee of the MPN, the search for a list of suppliers and his right to change attending physician.13 Joanne informs the insurance company that she wants a second opinion. She receives a list of doctors, selects one and makes an appointment. The second opinion doctor requests additional treatment for Joanne`s elbow. Joanne can now change her GP to the second opinion doctor or another doctor. Example: Randy injures his shoulder while working and notifies his employer. The employer sends Randy to the doctor the same day. A few days later, Randy receives information in the mail from the insurance company that there is an MPN.

Second- and third-opinion physicians must provide feedback within 20 days.23 However, since MPNs must be large enough to treat all injured workers, it is often not practical to restrict physicians. Therefore, the insurance company will first send an injured employee to a doctor, which is very convenient for the insurance company, hoping that the injured employee will not take any further action. All workers` compensation treatment is based on medical treatment guidelines that “determine the frequency, duration, intensity and appropriateness of all procedures and treatment arrangements commonly applied in workers` compensation cases.” 6 The objective is to ensure that injured workers receive a uniform level of care. Example: Nicholas injured his cervical spine nine months ago. His doctor initially said Nicolas had been temporarily disabled for six weeks. He then said Nicholas could return to work with light duty. Another attending physician may have given Nicholas a period of temporary disability of varying lengths. If an injured employee is not satisfied with the attending physician`s treatment program, they may get a second opinion from another physician. If the injured employee does not agree with the second opinion physician, he or she can get a third opinion. Two weeks ago, the doctor said that Nicholas` condition had stabilized and he had a permanent disability of his cervical spine of 17%.

The percentage rating is converted to monetary value. Another doctor may have given Nicholas a more or less permanent disability, which would affect the value of his case. Before returning to the industrial clinic, Andrea receives a letter from the insurance company containing the employer`s MFN web address.