The Role of Physician Assistants and Nurse Practitioners
in the Workers’ Compensation System
The Division of Workers’ Compensation has received an increasing number of inquiries concerning whether the use of Physician Assistants and Nurse Practitioners is permissible in workers’ compensation cases. The Division of Workers’ Compensation believes that Physician Assistants and Nurse Practitioners play a critical and fully authorized role in assuring that injured workers have timely access to high quality and cost effective medical treatment.
It is clear that no provision of the Labor Code prevents Physician Assistants or Nurse Practitioners, acting within the scope of their licensure, and under the appropriate degree of physician supervision, from providing medical treatment to injured workers.1 To the contrary, Labor Code Section 5307.1 provides, in pertinent part, that:
The administrative director shall include services provided by physical therapists, physician assistants, and nurse practitioners in the official (medical) fee schedule…. (Emphasis added.)
The Division believes that this provision clearly reflects the Legislature’s recognition that Physician Assistants and Nurse Practitioners are necessary and fully authorized providers of medical care in the workers’ compensation system.
The definition of "physician" in Labor Code Section 3209.3 expands the scope of the term "physician" to include additional medical practitioners such as acupuncturists, psychologists, and chiropractors who are not otherwise deemed "physicians" under the licensing laws covering doctors of medicine. This section does not bar Physician Assistants or Nurse Practitioners acting within the scope of their respective practices and under the appropriate physician supervision from providing treatment in workers' compensation cases.
The scope of practice for Nurse Practitioners is defined in Business and Professions Code Sections 2834 * 2837, and the regulations in the California Code of Regulations. Provisions for supervision of Nurse Practitioners are required to be set forth in the standardized procedure guidelines as provided for in Business and Professions Code Sections 2725 and 2836.1 and Title 16, California Code of Regulations, Section 1474.
The scope of practice and supervision requirements for Physician Assistants are contained in Business and Professions Code Sections 3500 - 3546, and Title 16, California Code of Regulations, Section 1399.540 through 1399.571.
While Physician Assistants and Nurse Practitioners may treat injured workers, they may not determine or report on an injured workers’ entitlement to benefits, including temporary disability. With respect to determining and reporting on an injured worker’s entitlement to compensation benefits, Labor Code Section 4061.5 provides that:
The treating physician primarily responsible for managing the care of the injured worker or the physician designated by that treating physician shall, in accordance with rules promulgated by the administrative director, render opinions on all medical issues necessary to determine eligibility for compensation.
Title 8, Cal. Code of Regulations Section 9785, also provides that:
(c) The primary treating physician, or a physician designated by the primary treating physician, shall make reports to the claims administrator as required in this section.
(d) The primary treating physician shall render opinions on all medical issues necessary to determine the employee's eligibility for compensation in the manner prescribed in subsections (e) ,2 (f)3 and (g)4 of this section.
Under these Labor Code and regulatory sections, a "physician" is obligated to make and report on any medical decision that initiates, terminates or materially changes the injured worker’s entitlement to any compensation as that term is defined in Labor Code Section 32075. Delegating the performance of these duties to a non-physician violates the obligations of a treating physician under both the Labor Code and Section 9785.