CompFox AI Summary
The Appeals Board denied the defendant's petition for reconsideration, upholding the administrative law judge's decision that the applicant could continue treatment with her chosen surgeon outside the defendant's Medical Provider Network (MPN). The defendant failed to provide proper notice of the MPN and applicant's rights, thus unreasonably refusing to authorize treatment and travel expenses. This failure to comply with MPN notification requirements meant the defendant remained liable for reasonable medical treatment self-procured by the applicant.
Full Decision Text1 Pages
The Appeals Board denied the defendant's petition for reconsideration, upholding the administrative law judge's decision that the applicant could continue treatment with her chosen surgeon outside the defendant's Medical Provider Network (MPN). The defendant failed to provide proper notice of the MPN and applicant's rights, thus unreasonably refusing to authorize treatment and travel expenses. This failure to comply with MPN notification requirements meant the defendant remained liable for reasonable medical treatment self-procured by the applicant.
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