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Compliance October 16, 2006
Employer Liable for Failure to Disclose Network Info
October 16, 2006 (PLANSPONSOR.com) - The California
Workers' Compensation Appeals Board has held that an employer
is liable for an employee's out-of-network medical costs
since it failed to inform him of its medical provider network
system.
Reported by Rebecca Moore
Business Insurance reports that, under workers comp reforms adopted in California in 2004, employers or their insurers are allowed to establish state-approved medical provider networks and direct employees to receive care under the networks. Employers or their insurers are required to properly notify employees about their use of a network, where and how to receive treatment, their right to be treated by a network doctor of their choice after the first visit, options for a second opinion, and other information.
United Parcel Service argued that it provided appropriate notice to the employee, but the employee and his attorney claim they received no notice for more than two months after the worker’s injury, according to Business Insurance. The employee had sought treatment from his own physician for an injured wrist, arm and shoulder sustained from a fall during package delivery.
The Appeals Board decided that the employer or insurer’s failure to provide notice of an employee’s rights under a medical network resulting in neglect of treatment made the employer or its insurer liable for the treatment obtained by the worker on his own.