California MPN Medical Disputes: Second Opinions, Third Opinions, and Independent Review

Review the primary official source.

Confirm the MPN and treating-physician path

A Medical Provider Network is an insurer- or employer-created network approved for workers’ compensation treatment. The claims administrator should provide MPN notices and access information. Before challenging care, confirm the MPN identity, treating physician, specialty, diagnosis, disputed treatment recommendation, geographic access, appointment attempts, and whether the dispute truly concerns treatment rather than a medical-legal evaluation.

Request and attend the second opinion

DWC guidance permits a worker who disputes an MPN treating physician’s diagnosis or treatment to obtain a second opinion from another MPN physician. Notify the designated employer or insurer contact of the dispute, select a doctor from the MPN list, make the appointment, and give the contact its date. Under the second- and third-opinion regulation (8 CCR section 9767.7), you must make the appointment within 60 days of receiving the provider list or waive the second-opinion process for that disputed diagnosis or treatment. Making the appointment is the deadline; the rule does not require the examination itself within those 60 days. The administrator must provide relevant medical records. Preserve the physician list used, selection notice, appointment requests, travel, record delivery, examination, and written opinion.

Use the third opinion when disagreement remains

If disagreement remains after the second opinion, a third MPN opinion may be requested. The same 60-day appointment-making requirement applies after receipt of the third-opinion provider list. Continue treatment with the treating doctor or another chosen MPN doctor during the opinion process. The same practical record matters: provider availability, appropriate specialty, timely appointment, complete records, and the precise disputed diagnosis or treatment. A missed appointment or incomplete record can obscure whether the process was actually exhausted. The third-opinion report and its service date should be retained because they affect the next step.

If the second- or third-opinion physician reviews the records and determines that the injury is outside that physician’s scope of practice, the physician must notify both the designated contact and the employee so an appropriate new MPN list can be provided. Preserve that notification and the replacement list rather than treating an unsuitable specialty assignment as a completed medical opinion. See section 9767.7(c), (e).

The second- and third-opinion physicians must give written opinions and, when applicable, alternative treatment recommendations. Recommended treatment must comply with Labor Code section 4616(e). Under section 9767.7(f)–(g), the employer or insurer must permit the recommended treatment within the MPN. If no MPN physician can provide it, the employee may choose a physician outside the MPN within a reasonable geographic area. Identify the recommendation and the network’s ability to provide that particular care; the regulation also allows treatment through a change to the second- or third-opinion physician or another MPN physician.

For help with the broader claim, see our California workers’ compensation practice.

Preserve independent-review rights

If you still dispute the third physician’s diagnosis or treatment, you may request MPN Independent Medical Review. The application process begins earlier: When you select the third-opinion physician, the MPN contact must explain independent review and provide the application with the MPN contact’s section completed. After the disputed third opinion, complete the employee section and file the application with the Administrative Director. Choose an in-person examination or a records review and identify the disputed diagnosis or treatment. These steps appear in title 8, section 9768.9(a)–(b).

An in-person review has another clock. Within 60 calendar days after receiving the selected reviewer’s name, contact that reviewer to arrange the appointment. Failure to make that contact waives the MPN independent-review process for this disputed diagnosis or treatment by this treating physician. The reviewer must schedule the examination within 30 calendar days after your appointment request unless all parties agree to a later date. The 60-day period runs from receipt of the reviewer’s name—not from the third-opinion report—and requires contacting the reviewer, rather than completing the examination within that period. See section 9768.9(f), (h).

Keep the completed application, filing proof, reviewer-selection notice and appointment-contact confirmation. Those documents show different steps; submitting the application does not arrange an examination. Continue treatment within the MPN during this process under section 9768.9(j). MPN independent review is distinct from utilization-review IMR and from a QME panel. A treatment-necessity denial, emergency or network-access problem may require a different response, so identify the actual decision before choosing the procedure.

Records for an MPN treatment-dispute review

• MPN notices and network identification
• first, second, and third physician reports
• provider-selection and appointment records
• medical-record transmittals
• independent-review form, submission proof, and decision

A separate question is whether you can choose your own treating doctor.