Hartford Insurance Company of the Midwest
Medical Provider Network (MPN)
The Hartford Insurance Company of the Midwest Insurance Company/TMC MPN operates in conjunction with your workers' compensation policy with the goal of providing your employees with prompt, appropriate, and quality medical care. By utilizing the MPN, you help manage your workers' compensation medical costs by using providers who are recognized in the industry as professionals specializing in occupational health care engaged in the shared objective of treating the medical concerns of your employees injured-on-the-job and returning them to work safely with minimal lost time. With some exceptions, a claim that is administered within the MPN will have all medical treatment exclusively provided within the network.
You have an important responsibility as an employer in successfully implementing the MPN. This success depends largely on your becoming familiar with the new laws and procedures that are explained in a Letter explaining your Employer's Responsibilities . These can be found in the “ Print MPN Letters/Forms ” link below. Please take the opportunity to read and get familiar with your responsibilities under the MPN. These responsibilities can be summarized as follows:
Maintain a posting notice to employees displayed in a conspicuous location at your work site, providing information about the workers' compensation carrier, and other information about workers' compensation as required by state law.
Maintain a supplemental form to be placed near the posting notice, containing information about the designated local acute and non-acute medical provider within the MPN. This notice is supplied to you by AARLA, and another copy can be found by clicking on the “Provider Lookup” link below.
• Maintain a copy of the Complete Written MPN Employee Notification displayed in a conspicuous location at your work site in close proximity to the posting notice.
Within one day of the injury, arrange for medical care needed, in the case of an emergency by calling 911, or in the case of a non-emergency by directing the employee to promptly seek treatment with the MPN designated provider.
Provide the employee with a DWC-1 Claim form within 24 hours of the injury.
Report the injury promptly to AARLA by phone to 800-500-3744, or by fax to 800-500-3486.
Communicate to your employees about the MPN, by providing them with the MPN Implementation Notice. Also, if an injury occurs, you will need to provide the injured employee a copy of the Complete Written MPN Employee Notification along with a DWC-1 claim form. This must be provided in English to all employees, and in Spanish to all Spanish-speaking employees. Employee Notification Letter.
Advise the employee of his or her right to pre-designate a personal treating physician rather than use the MPN for an industrial injury or illness. You are required to provide a Pre-Designation form to your employee at the time of hire; the employee wishing to pre-designate is required to fill out and sign the form and have it signed by a consenting physician, and return it to you.
Have your employee sign and retain in your personnel file a copy of the Acknowledgment of Receipt of the Complete Written MPN Employee Notification
• If you had an MPN program with your prior insurance carrier, provide each employee who was previously injured on the job with a MPN Termination or Cessation of Use form. You will need to fill out the information about your prior carrier’s MPN, including the MPN Contact information, and date of MPN Termination or Cessation of Use.
Maintain on file a copy of the Continuity of Care and Transfer of Care policies .
Use the “Provider Lookup” feature to search for medical providers within the MPN for a designated search area. You can also use this to create and print custom provider directories and posting notices for your workplace.
AARLA as your workers' compensation claims administrator is committed to helping you with informational materials and a Call Center available Monday through Friday, 8 a.m. to 5 p.m. Feel free to direct any inquiries you may have about the Medical Provider Network to the Call Center staff at 866-536-2853. In addition to links to the forms and letters and to the “Provider Lookup” feature, there is also a website link provided for your assistance for Frequently Asked Questions About the MPN, and a link to the State of California DWC Website's page about MPNs