Home/Case Law/WESLEY VAUGHN vs. THE KROEGER COMPANY dba RALPHS GROCERY COMPANY, SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.
Regular DecisionReconsideration

WESLEY VAUGHN vs. THE KROEGER COMPANY dba RALPHS GROCERY COMPANY, SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

Filed: Jan 31, 2020
Long Beach
ADJ12384017

CompFox AI Summary

The Appeals Board granted reconsideration and rescinded the WCJ's finding that the applicant did not properly predesignate his physician. The Board determined that the sole issue presented to the WCJ was too narrowly framed, failing to address the applicant's arguments regarding substantial compliance and the defendant's alleged failure to provide proper notice of predesignation rights. The case is remanded for further proceedings to address the issues of proper notice and denial of care, which are crucial for determining treatment outside the Medical Provider Network.

Full Decision Text1 Pages

The Appeals Board granted reconsideration and rescinded the WCJ's finding that the applicant did not properly predesignate his physician. The Board determined that the sole issue presented to the WCJ was too narrowly framed, failing to address the applicant's arguments regarding substantial compliance and the defendant's alleged failure to provide proper notice of predesignation rights. The case is remanded for further proceedings to address the issues of proper notice and denial of care, which are crucial for determining treatment outside the Medical Provider Network.

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