Where this sits
- Chapter 4.5.
- Division of Workers' Compensation
- Subchapter 1. Administrative Director--Administrative Rules
- Article 3.5. Medical Provider Networks
The regulation, as printed
(a) A MPN must have at least three available physicians of each specialty to treat common injuries experienced by injured employees based on the type of occupation or industry in which the employee is engaged and within the access standards set forth in (1) and (2). (1) An MPN must have at least three available primary treating physicians and a hospital for emergency health care services, or if separate from such hospital, a provider of all emergency health care services, within 30 minutes or 15 miles of each covered employee's residence or workplace.
What panels did with this rule
Released decisions that named § 9767.5, with the passage each turned on. A panel decision persuades; it does not bind.
- ADJ12308686 · 2026-06-11 · Los Angeles District Office8 CCR § 9767.5
Determinative passage · p.5The MPN access standards measure adequacy for brain-injury conditions according to the availability of recognized medical specialists. There is no board-certified specialty titled "brain injury specialist" in the manner that neurology exists as an established specialty. A boardcertified neurologist possesses the medical qualifications necessary to diagnose, treat, and manage brain injuries including post-concussion syndrome and post-traumatic vertigo. Defendant therefore satisfied its obligation under section 4600 when it provided applicant with the names of three qualified neurologists located within the required geographic boundaries.
Defendant met requirements by providing access to three neurologists within the MPN for applicant's brain injury condition.
Official decision · page 5 → - ADJ15329380 · 2025-10-31 · Anaheim District Office8 CCR § 9767.5
Determinative passage · p.6(Lab. Code, § 5811(b)(2).) Here, defendant contends that the medical treatment given by Dr. Russman, during which time the disputed interpreting services were used, was not reasonable and necessary because applicant improperly treated outside the defendant's MPN, and, as a result, lien claimant's services are similarly unreasonable, unnecessary, and non-recoverable. (Petition, p. 2.) As parties are well aware, it is defendant's burden to establish the existence of the MPN, and that written notification of the MPN, and all other requisite information under AD Rule 9767.12, was provided to applicant, both before and after the subject injury. (Cal. Code Regs., tit. 8, § 9767.12.) Treatment through the MPN must also be accessible, not neglectful, and actually available to applicant. (See Cal. Code Regs., tit. 8, § 9767.5; Lab. Code, § 4600(a); see also McCoy v. I.A.C. (1966) 64 Cal.2d 82, 87 [31 Cal.Comp.Cases 93] ["the employer is required to provide treatment which is reasonably necessary to cure or relieve the employee's distress, and if he neglects or refuses to do so, he must reimburse the employee for his expenses in obtaining such treatment"].) Although notice of the MPN was apparently given to applicant after the injury (Defense Exhibit C), defendant failed to produce evidence that Dr. Greene was in fact listed within the MPN and provided actual treatment to applicant.
Applied to determine whether applicant improperly treated outside the MPN.
Official decision · page 6 → - ADJ13323913 · 2024-12-16 · Los Angeles District Office8 CCR § 9767.5
Determinative passage · p.6AD Rule 9767.12 provides for notification of the MPN as follows: (a) When an injury is reported or an employer has knowledge of an injury that is subject to an MPN or when an employee with an existing injury is required to transfer treatment to an MPN, a complete written MPN employee notification with the information specified in paragraph (2) of this subdivision, shall be provided to the covered employee by the employer or the insurer for the employer. This MPN notification shall be provided to employees in English and also in Spanish if the employee primarily speaks Spanish.
Defendant's April 9, 2020 letter failed to meet notification requirements, contributing to liability for treatment costs.
Official decision · page 6 → - ADJ16590361 · 2023-10-16 · San Francisco District Office8 CCR § 9767.5
Determinative passage · p.1If an employer has established an MPN, injured workers are generally limited to treating with a physician from within the employer's MPN. (Lab. Code, § 4600(c), 4616 et seq.) However, if the employer neglects or refuses to provide reasonably necessary medical treatment, whether
Applicant failed to prove defendant's MPN did not meet access standards, but defendant neglected to provide treatment within the MPN.
Official decision · page 1 → - ADJ12031213 · 2021-06-29 · Van Nuys District Office8 CCR § 9767.5
Determinative passage · p.11referral, not to the scheduling of an initial appointment with a primary treating physician.4 The Rule references "specialist services" and "a specialist in an appropriate referred specialty." As discussed above, the Rules distinguish between a specialist and a primary treating physician. The language of AD Rule 9767.5(g) suggests that it applies where there has been a referral to a specialist, particularly since applying this Rule to an initial appointment with a primary treating physician potentially creates conflicting timeframes within the Rule. (See Cal. Code Regs., tit. 8, § 9767.5(f).) Moreover, this reading comports with the interpretation endorsed by the panel in Gomez of a previous version of this regulatory subdivision: "Where there has been a referral to a specialist for non-emergency services, the MPN must provide an appointment within 20 days of the referral within the MPN. (AD Rule 9767.5(g).)"5 (Gomez, supra, at pp. *9-10.)
Rule applies only to specialist referrals, not initial PTP appointments; applicant did not show rule was violated.
Official decision · page 11 → - ADJ13521927 · 2021-05-28 · Los Angeles District Office8 CCR § 9767.5
Determinative passage · p.64 Moreover, AD Rule 9767.5(f) does not provide the remedy of treating outside the MPN for failure to comply with it. AD Rule 9767.5(c) provides for treatment outside the MPN where the employee "is not able to obtain from an MPN physician reasonable and necessary medical treatment within the applicable access standards in subdivisions (a) or (b) and the required time frames in subdivisions (f) and (g)..." Applicant has not shown that all of the conditions in subdivision (c) are present in this matter such that she may be permitted to treat outside the MPN per AD Rule 9767.5(c).
Applicant did not show conditions for treatment outside MPN were met.
Official decision · page 6 → - ADJ12439078 · 2021-05-13 · Van Nuys District Office8 CCR § 9767.5
Determinative passage · p.3The issue at bar involves Medical Provider Network (MPN) access standards, and the minimum number of physicians of a particular specialty available to act as the primary treating physician (PTP). In an October 7, 2020 Findings of Fact, the undersigned found that so long as the MPN has three physicians of various specialties appropriate to the type of occupation or industry in which the employee is engaged, the access standards set forth in Title 8, Cal. Code Regs. § 9767.5 are satisfied. Applicant is aggrieved by this finding, and seeks removal/reconsideration. The matter is not on calendar.
Requires at least three physicians of each specialty appropriate to the occupation or industry to be available as primary treating physicians, but does not require three of every possible specialty.
Official decision · page 3 →
Rules beside this one
Article 3.5. Medical Provider Networks — regulations rarely stand alone, and the answer is often two sections away.
- § 9767.2Review of Medical Provider Network Application.
- § 9767.3Application for a Medical Provider Network Plan.2 decisions
- § 9767.4Cover Page for Medical Provider Network Application or Plan for Reapproval.
- § 9767.6Treatment and Change of Physicians Within MPN6 decisions
- § 9767.7Second and Third Opinions1 decisions
- § 9767.8Modification of Medical Provider Network Plan