2026 Legislative Passage of Reforms to Labor & Industries Medical Provider Network Will Increase Access to Care for Washington’s Injured Workers


John Webber, Attorney and Managing Shareholder of GLP Attorneys WSCA Leadership Level Corporate Partner


Washington State’s workers’ compensation system is among the most distinctive in the United States. Administered by the Department of Labor & Industries (L&I) or a self-insured entity (SIE), it has evolved over more than a century to balance worker protections, employer costs, and medical outcomes. One of the most significant modern reforms to the system was the creation of the Medical Provider Network (MPN), which fundamentally reshaped how injured workers access care.


Early Reform Efforts and the Creation of the MPN


For decades, injured workers in Washington retained broad discretion in selecting their treating providers, with L&I reimbursing providers directly. Beginning in the early 2000s, however, pressure for reform intensified. Policymakers and stakeholders raised concerns about rising system costs, inconsistent medical outcomes, prolonged disability durations, and a lack of standardized treatment practices.


These concerns reflected national trends, as states across the country increasingly adopted provider networks. Thes networks organized groups of physicians and healthcare professionals who agree to meet defined standards and follow treatment guidelines.


In 2011, Washington enacted significant workers’ compensation reforms directing L&I to establish a statewide Medical Provider Network. The stated goals were to improve quality and consistency of care, promote evidence-based treatment, reduce long-term disability, and control system-wide costs. Providers seeking to participate in the network were required to meet specific criteria and agreed to follow established treatment guidelines and outcome tracking requirements.


The MPN officially launched in 2013, marking a fundamental shift in the delivery of care. Injured workers retained the right to seek initial treatment from any provider, but ongoing care required selection of a provider within the network. This structure was intended to strike a balance between patient choice and system oversight.


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The network expanded rapidly. By 2014, it included more than 20,000 providers, and data indicated that 99 percent of injured workers in Washington lived within 15 miles of at least five network providers. This growth helped address early concerns that the MPN might limit access to care.


Implementation Challenges and Growing Concerns


In the decade following implementation, significant concerns emerged regarding the operation of the MPN. Central among these was the increasing rigidity of L&I’s treatment guidelines and the growing control exercised over medical decision-making.


Providers reported pressure to adhere strictly to agency guidelines, with independent clinical judgment often overridden. Treatment recommendations were frequently delayed or denied, and guidelines that were intended to be advisory were applied as de facto mandates. As a result, injured workers were often forced into lengthy appeals or litigation to obtain medically necessary care.


These dynamics had broader system impacts. Some highly qualified providers chose to leave the MPN, reducing available options for injured workers. Access challenges became particularly acute in rural areas, where workers were sometimes required to travel significant distances to obtain care. At the same time, reports emerged of employer influence over provider selection, further limiting meaningful patient choice.


Judicial Intervention: Murray v. Department of Labor & Industries


In 2018, the Washington State Supreme Court addressed these issues in Murray v. Department of Labor & Industries. In a unanimous decision, the Court held that injured workers are entitled to individualized coverage determinations by L&I.


While the decision reaffirmed the importance of case-specific medical judgment, disputes over treatment continued in practice, often requiring costly and time-consuming litigation to resolve.


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