As the Legislature printed it
DIVISION 4. WORKERS' COMPENSATION AND INSURANCE [3200 - 6002] · PART 2. COMPUTATION OF COMPENSATION [4451 - 4856] · CHAPTER 2. Compensation Schedules [4550 - 4856] · ARTICLE 2.3. Medical Provider Networks [4616 - 4616.7]
(a) (1) An insurer, employer, or entity that provides physician network services may establish or modify a medical provider network for the provision of medical treatment to injured employees. The network shall include physicians primarily engaged in the treatment of occupational injuries. The administrative director shall encourage the integration of occupational and nonoccupational providers. Subject to Section 3209.11, the number of physicians in the medical provider network shall be sufficient to enable treatment for injuries or conditions to be provided in a timely manner. The provider network shall include an adequate number and type of physicians, as described in Section 3209.3, or other providers, as described in Section 3209.5, to treat common injuries experienced by injured employees based on the type of occupation or industry in which the employee is engaged, and the geographic area where the employees are employed. (2) Medical treatment for injuries shall be readily available at reasonable times to all employees. To the extent feasible, all medical treatment for injuries shall be readily accessible to all employees. With respect to availability and accessibility of treatment, the administrative director shall consider the needs of rural areas, specifically those in which health facilities are located at least 30 miles apart and areas in which there is a health care shortage. (3) A treating physician shall be included in the network only if, at the time of entering into or renewing an agreement by which the physician would be in the network, the physician, or an authorized employee of the physician or the physician’s office, provides a separate written acknowledgment in which the physician affirmatively elects to be a member of the network. Copies of the written acknowledgment shall be provided to the administrative director upon the administrative director’s request. This paragraph shall not apply to a physician who is a shareholder, partner, or employee of a medical group that elects to be part of the network. (4) (A) (i) Commencing July 1, 2021, every medical provider network shall post on its internet website a roster of all participating providers, which includes all physicians and ancillary service providers in the medical provider network, and shall update the roster at least quarterly. Every network shall provide to the administrative director the internet website address of the network and of its roster of participating providers. The roster of participating providers shall include, at a minimum, the name of each individual provider and their office address and office telephone number. If the ancillary service is provided by an entity rather than an individual, then that entity’s name, address, and telephone number shall be listed. (ii) The administrative director shall post, on the division’s internet website, the internet website address of every approved medical provider network. (B) Every medical provider network shall post on its internet website information about how to contact the medical provider network contact and medical access assistants, and information about how to obtain a copy of any notification regarding the medical provider network that is required to be given to an employee by regulations adopted by the administrative director. (5) Every medical provider network shall provide one or more persons within the United States to serve as medical access assistants to help an injured employee find an available physician of the employee’s choice, and subsequent physicians if necessary, under Section 4616.3. Medical access assistants shall have a toll-free telephone number that injured employees may use and shall be available at least from 7 a.m. to 8 p.m. Pacific standard time, Monday through Saturday, to respond to injured employees, contact physicians’ offices during regular business hours, and schedule appointments. The administrative director shall promulgate regulations governing the provision of medical access assistants. (b) (1) An insurer, employer, or entity that provides physician network services shall submit a plan for the medical provider network to the administrative director for approval. The administrative director shall approve the plan for a period of four years if the administrative director determines that the plan meets the requirements of this section. If the administrative director does not act on the plan within 60 days of submitting the plan, it shall be deemed approved. Commencing January 1, 2014, existing approved plans shall be deemed approved for a period of four years from the approval date of the most recent application or modification submitted prior to 2014. Plans for reapproval for medical provider networks shall be submitted at least six months before the expiration of the four-year approval period. Commencing January 1, 2016, a modification that updates an entire medical provider network plan to bring the plan into full compliance with all current statutes and regulations shall be deemed approved for a period of four years from the modification approval date. An approved modification that does not update an entire medical provider network plan to bring the plan into full compliance with all current statutes and regulations shall not alter the expiration of the medical provider network’s four-year approval period. Upon a showing that the medical provider network was approved or deemed approved by the administrative director, there shall be a conclusive presumption on the part of the appeals board that the medical provider network was validly formed. (2) Every medical provider network shall establish and follow procedures to continuously review the quality of care, performance of medical personnel, utilization of services and facilities, and costs. (3) Every medical provider network shall submit geocoding of its network for reapproval to establish that the number and geographic location of physicians in the network meets the required access standards. (4) Approval of a plan may be denied, revoked, or suspended if the medical provider network fails to meet the requirements of this article. Any person contending that a medical provider network is not validly constituted may petition the administrative director to suspend or revoke the approval of the medical provider network. The administrative director may adopt regulations establishing a schedule of administrative penalties not to exceed five thousand dollars ($5,000) per violation, or probation, or both, in lieu of revocation or suspension for less severe violations of the requirements of this article. Penalties, probation, suspension, or revocation shall be ordered by the administrative director only after notice and opportunity to be heard. Unless suspended or revoked by the administrative director, the administrative director’s approval of a medical provider network shall be binding on all persons and all courts. A determination of the administrative director may be reviewed only by an appeal of the determination of the administrative director filed as an original proceeding before the reconsideration unit of the workers’ compensation appeals board on the same grounds and within the same time limits after issuance of the determination as would be applicable to a petition for reconsideration of a decision of a workers’ compensation administrative law judge. (c) Physician compensation may not be structured in order to achieve the goal of reducing, delaying, or denying medical treatment or restricting access to medical treatment. (d) If the employer or insurer meets the requirements of this section, the administrative director may not withhold approval or disapprove an employer’s or insurer’s medical provider network based solely on the selection of providers. In developing a medical provider network, an employer or insurer shall have the exclusive right to determine the members of their network. (e) All treatment provided shall be provided in accordance with the medical treatment utilization schedule established pursuant to Section 5307.27. (f) Only a licensed physician who is competent to evaluate the specific clinical issues involved in the medical treatment services, when these services are within the scope of the physician’s practice, may modify, delay, or deny requests for authorization of medical treatment. (g) Every contracting agent that sells, leases, assigns, transfers, or conveys its medical provider networks and their contracted reimbursement rates to an insurer, employer, entity that provides physician network services, or another contracting agent shall, upon entering or renewing a provider contract, disclose to the provider whether the medical provider network may be sold, leased, transferred, or conveyed to other insurers, employers, entities that provide physician network services, or another contracting agent, and specify whether those insurers, employers, entities that provide physician network services, or contracting agents include workers’ compensation insurers. (h) On or before November 1, 2004, the administrative director, in consultation with the Department of Managed Health Care, shall adopt regulations implementing this article. The administrative director shall develop regulations that establish procedures for purposes of making medical provider network modifications. (i) The administrative director has the authority and discretion to investigate complaints, conduct random reviews, and take enforcement action against medical provider networks, an entity that provides ancillary services, or an entity providing services for or on behalf of the medical provider network or its providers regarding noncompliance with the requirements of this section or Section 4603.2 or 4610.
How panels applied this section
Newest released decisions whose legal-standard extraction named this section. Each quotes the passage and links to the official PDF. Unofficial guide — not legal advice.
- ADJ12308686 · 2026-06-11 · Los Angeles District Office§ 4616
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 → - ADJ19137360 · 2026-03-23 · Los Angeles District Office§ 4616
Determinative passage · p.12No, Applicant may not ignore Defendant's MPN and obtain evaluation and treatment from a non-MPN provider once Applicant has been advised of their rights and responsibilities to treat within Defendant's MPN, as indicated below. Once Applicant has been advised of their rights and responsibilities to treat within Defendant's MPN, lien claimant, standing in Applicant's shoes, has the burden to prove that there was some kind of denial of care that would entitle Applicant to treat outside of that MPN pursuant to the Knight decision (Knight v. UPS (2006) 71 Cal. Comp. Cases 1423 (en banc)) and pursuant to Labor Code § 4616.3(b). As indicated below, there was no showing of any denial of care by Defendant to Applicant. The services of lien claimant, Physical Rehab Services, would be considered self-procured treatment and Defendant is not responsible for reimbursement for those services.
Applicant was advised of MPN rights and responsibilities; no denial of care established.
Official decision · page 12 → - ADJ8112676 · 2025-12-16 · Los Angeles District Office§ 4616
Determinative passage · p.3Section 4616(b)(4) provides that, "[a] determination of the administrative director may be reviewed only by an appeal of the determination of the administrative director filed as an original proceeding before the reconsideration unit of the workers' compensation appeals board on the same grounds and within the same time limits after issuance of the determination as would be applicable to a petition for reconsideration of a decision of a workers' compensation administrative law judge." (§ 4616(b)(4).) WCAB Rule 10560 provides that, "[w]here the Labor Code provides that the Workers' Compensation Appeals Board has jurisdiction over appeals from or enforcement of an order, any aggrieved party may appeal or seek to enforce an order issued by the Division of Workers' Compensation Administrative Director or the Director of Industrial Relations by filing
Applied to determine the appealability and timeliness of the petitions.
Official decision · page 3 → - ADJ15987729 · 2024-10-14 · Los Angeles District Office§ 4616
Determinative passage · p.6Labor Code Section 4616(b) (1) provides in pertinent part, "Upon a showing that the medical provider network was approved or deemed approved by the administrative director, there shall be a conclusive presumption on the part of the appeals board that the medical provider network was validly formed."
Applied to uphold the validity of Defendant's MPN.
Official decision · page 6 → - ADJ10740002 · 2024-07-23 · Oakland District Office§ 4616
Determinative passage · p.6"Ancillary services" are defined as the "provision of medical services or goods as allowed in Labor Code section 4600 by a non-physician, including, but not limited to, interpreter services." (Tit 8, Cal. Code Regs, § 9767.1(a)(1).) Therefore, defendants are entitled to include interpreters related to medical treatment in their MPNs, and that defendants will not be liable for the costs of those interpreters if an applicant impermissibly obtains interpreting services outside of that MPN.
Defendant's MPN included interpreter services as ancillary services, and lien claimant was not part of the MPN, so defendant was not liable for lien payment.
Official decision · page 6 → - ADJ11289849 · 2024-06-18 · Long Beach District Office§ 4616
Determinative passage · p.7The requirements and regulations for the establishment of a medical provider network are outlined in Labor Code § 4616. Pursuant to Section 4616(b)(1), "upon a showing that the medical provider network was approved...by the administrative director, there shall be a conclusive presumption on the part of the appeals board that the medical provider network was validly formed."
The Board found a conclusive presumption of valid MPN formation upon showing administrative director approval.
Official decision · page 7 → - ADJ808475 · 2023-08-25 · Van Nuys District Office§ 4616
Determinative passage · p.2The injured employee may be transferred into the MPN for medical treatment unless certain exceptions apply. (Cal. Code Regs., tit. 8, § 9767.9(a).) One exception allows an additional year of treatment outside the MPN when the injured employee has a serious chronic condition. (Cal. Code Regs., tit. 8, § 9767.9(e)(2).) Applicant was provided with an additional year of treatment outside of the MPN due to his serious chronic condition. (Report, pp. 3-4.)
Defendant followed the required steps for transfer to MPN, and applicant received proper notice and additional time for treatment outside the MPN due to a serious chronic condition.
Official decision · page 2 → - ADJ14808720 · 2022-05-16 · Van Nuys District Office§ 4616
Determinative passage · p.3(4) Approval of a plan may be denied, revoked, or suspended if the medical provider network fails to meet the requirements of this article. Any person contending that a medical provider network is not validly constituted may petition the administrative director to suspend or revoke the approval of the medical provider network.... Unless suspended or revoked by the administrative director, the administrative director's approval of a medical provider network shall be binding on all persons and all courts. A determination of the administrative director may be reviewed only by an appeal of the determination of the administrative director filed as an original proceeding before the reconsideration unit of the workers' compensation appeals board on the same grounds and within the same time limits after issuance of the determination as would be applicable to a petition for reconsideration of a decision of a workers' compensation administrative law judge.... (Lab. Code, § 4616, emphasis added.)2
Applied to determine that the WCAB lacks jurisdiction to declare the MPN invalid once approved by the administrative director.
Official decision · page 3 →
All 15 decisions naming § 4616 →
The rules written under this section
A statute says what is owed; Title 8 says by when, on what form, and what happens if the deadline passes. These name § 4616as what they implement.
- 8 CCR § 9767.1Medical Provider Networks -- Definitions.
- 8 CCR § 9767.2Review of Medical Provider Network Application.
- 8 CCR § 9767.3Application for a Medical Provider Network Plan.
- 8 CCR § 9767.4Cover Page for Medical Provider Network Application or Plan for Reapproval.
- 8 CCR § 9767.6Treatment and Change of Physicians Within MPN
- 8 CCR § 9767.7Second and Third Opinions
- 8 CCR § 9767.9Transfer of Ongoing Care into the MPN.
- 8 CCR § 9767.13Denial of Approval of Application or Reapproval; Re-Evaluation.
- 8 CCR § 9767.14Probation, Suspension or Revocation of Medical Provider Network Plan; Hearing.
- 8 CCR § 9767.15Compliance with Current MPN Regulations; Reapproval.
- 8 CCR § 9767.16Medical Provider Network Complaints.
- 8 CCR § 9767.16.5DWC Medical Provider Network Complaint Form 9767.16.5.
- 8 CCR § 9767.17Petition for Suspension or Revocation of a Medical Provider Network.
- 8 CCR § 9767.17.5DWC Petition for Suspension or Revocation of a Medical Provider Network Form
- 8 CCR § 9767.18Random Reviews.
- 8 CCR § 9767.19Administrative Penalty Schedule; Hearing, Mitigation and Appeal.
- 8 CCR § 9780.1Employee's Predesignation of Personal Physician.
- 8 CCR § 9782Notice to Employee of Right to Choose Physician.
- 8 CCR § 10101.1Claim File--Contents.
- 8 CCR § 10139Workers' Compensation Claim Form (DWC 1) and Notice of Potential Eligibility.
- 8 CCR § 10580Petition Appealing Medical Provider Network Determination of the Administrative Director.
- 8 CCR § 10959Petition Appealing Medical Provider Network Determination of the Administrative Director. [Renumbered]repealed
Also on this
Unofficial guide — not legal advice. The statute is the state’s text. The quotes are litigated applications, not a prediction.
About California Labor Code § 4616
What is California Labor Code § 4616?
Labor Code § 4616 sits in ARTICLE 2.3. Medical Provider Networks [4616 - 4616.7]. The statute on this page begins: (a) (1) An insurer, employer, or entity that provides physician network services may establish or modify a medical provider network for the. The official display is on LegInfo; this is a reprint.
Did WCAB panels apply Labor Code § 4616 in this corpus?
This corpus has 15 released decisions whose extracted legal standards named § 4616. Quotes and PDFs are on this page. That is not every case in California that ever cited the section.