ALICE RIVERA PASILLAS vs. DURHAM D M, OLD REPUBLIC INSURANCE COMPANY, SEDGWICK CMS

This case involves a worker's claim that she was denied medical care, thus allowing her to seek treatment outside her employer's network. The applicant's attorney argued that the employer failed to provide authorization for treatment with a network physician. However, the Administrative Law Judge (WCJ) found that the employer had provided timely authorization, evidenced by a fax confirmation and proof of service, and that the applicant's claim of non-receipt was insufficient to rebut the presumption of delivery. The Workers' Compensation Appeals Board (WCAB) reviewed the petition for reconsideration, adopted the WCJ's reasoning, and affirmed the original findings. Therefore, the WCAB upheld the decision that the applicant did not prove a denial of care.