Can an Out-of-Network Doctor Provide Case Evidence?
Workers' compensation has definite rules about using employer's Medical Provider Networks (MPN), how long you must wait before switching to your own personal practitioner and using a Qualified Medical Examiner to resolve disputes. But is the medical report from an out-of-network physician admissible as evidence in your workers’ comp claim?
This was the point addressed by the California Supreme Court in the recent case, Valdez v. Workers’ Compensation Appeals Board. The claimant Valdez suffered an injury from a fall at work. When dissatisfied with treatment from her employer's MPN physician, she paid for her own treatment through an out-of-network doctor, recommended by her lawyer. When she applied for temporary disability benefits, she used the out-of-network doctor's reports to substantiate her condition.
The employer argued that out-of-network medical reports were inadmissible for proceedings. The workers' compensation judge (WCJ) overruled the objection and awarded temporary disability benefits and attorney fees. The employer sought reconsideration and the WCJ ruled the reports were admissible, but the employer may not be responsible for that doctor's treatment fees. The Appeals Board reversed the decision. After further reconsideration and higher appeals the case went before the state Supreme Court.
The Supreme Court found:
- Parties are not prohibited from obtaining medical evaluations or consultations at their own expense
- All comprehensive medical evaluations obtained by any party are admissible in any proceedings before the appeals board (other than exceptions as prohibited by the statutes)
- No statutes referenced in the case restricted admissibility of medical evaluations
This case established a valuable precedent for Orange County workers' compensation lawyers to use when gathering evidence and appealing decisions on behalf of their clients.