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Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. ADJ560768 (SJO 0256445)
Regular
Nov 29, 2011

MARK CAMPAGNA vs. AMERICAN CORP./AMERICAN AIRLINES; AMERICAN HOME ASSURANCE, SPECIALTY RISK SERVICES

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to lien claimant Access Mediquip's petition. The WCAB found that Access Mediquip's objection to the Order Dismissing Lien was timely filed, despite the WCJ's initial belief to the contrary. Therefore, the WCAB rescinded the dismissal order and remanded the case to the trial level for further proceedings. This decision hinges on the correct calculation of the response deadline for the Notice of Intention to Dismiss Lien.

Workers' Compensation Appeals BoardPetition for ReconsiderationOrder Dismissing LienNotice of Intention to Dismiss LienLien claimantPinnacle Lien ServicesAccess MediquipWCJPermanent disabilityMedical treatment
References
Case No. ADJ3491952
Regular
Sep 04, 2012

ELISEO CHACON vs. PICO RIVERA PALLETS INCORPORATED, CALIFORNIA INSURANCE COMPANY

This case involves a lien claimant, Access Mediquip, seeking payment for surgical implants. The Workers' Compensation Judge disallowed the lien, finding the claimant not credible regarding the actual costs of the implants, despite acknowledging their provision. Access Mediquip filed a petition for reconsideration, but the Appeals Board dismissed it. The dismissal was based on the petition being untimely filed 26 days after the judge's decision was mailed, exceeding the statutory 20-day period extended by 5 days for mail service.

Workers' Compensation Appeals BoardLien claimantPetition for reconsiderationTimelinessDismissalWCJ decisionLumbar fusion surgeryAccess MediquipPico Rivera PalletsCalifornia Insurance Company
References
Case No. ADJ1660426 (FRE 0225153)
Regular
Jul 19, 2012

Barbara Haskin vs. Fresno Unified School District

The Workers' Compensation Appeals Board granted reconsideration for lien claimant Access Mediquip against Fresno Unified School District. The WCJ had previously ruled that the lien claimant take nothing, finding the defendant had no obligation to them. However, the Appeals Board found the record deficient, lacking admitted evidence necessary for a fair adjudication. Consequently, the prior decision was rescinded, and the case was returned for further proceedings and a new decision.

Access MediquipPinnacle Lien Servicesspinal surgeryimplantable devicesSynthes invoiceadmitted evidenceevidentiary recordFileNetEAMSHamilton v. Lockheed
References
Case No. ADJ2639881
Regular
Jun 07, 2013

DINA MESSIER vs. COUNTY OF SACRAMENTO

This case involves a lien claimant, Access Mediquip, seeking reconsideration of an order dismissing its lien. The claimant argues the dismissal was erroneous because it lacked notice and an opportunity to present arguments regarding the statute of limitations. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, finding that the claimant was denied due process. The WCAB rescinded the dismissal order and returned the matter to the trial level for further proceedings and a new decision.

Lien claimantReconsiderationOrder Dismissing LienStatute of limitationsDue processWCJWorkers' Compensation Appeals BoardAccess MediquipPinnacle Lien ServicesCounty of Sacramento
References
Case No. ADJ7099047
Regular
Dec 13, 2010

NORMA GILLEY vs. CITY OF OCEANSIDE

The Workers' Compensation Appeals Board granted reconsideration of a prior decision that disallowed lien claimant Access Mediquip's claim for $17,685 in medical devices. The original ruling found that the defendant's payment to another provider for the surgery included the cost of these devices. The Board rescinded this decision and returned the case for further development of the record. The primary issue is whether the defendant's payment to the surgical facility satisfied their obligation to pay for the implanted devices, and to what extent.

Workers' Compensation Appeals BoardNorma GilleyCity of OceansideAccess MediquipLLCLien claimantMedical devicesStryker devicesMedial compartmental arthroplastyFindings and Order
References
Case No. ADJ5827846
Regular
May 29, 2013

TSHEA PARTNER vs. SOUTHERN CALIFORNIA EDISON

This Workers' Compensation Appeals Board case denied reconsideration of a lien claim by Pinnacle Lien Services on behalf of Access Mediquip. The applicant received spinal stimulator implants, and the lien claimant sought payment for implantable devices. The Appeals Board adopted the judge's report, which found that the charges for the implantable devices were included in the payments made to the surgery center. The court determined that the lien claimant failed to provide sufficient evidence to prove the defendant's liability for these separately itemized devices.

Petition for ReconsiderationWorkers' Compensation Appeals BoardSouthern California EdisonPinnacle Lien ServicesAccess MediquipSpinal stimulatorImplantable devicesCPT codesAmbulatory Surgery CenterDe Anza Ambulatory Surgery Center
References
Case No. ADJ9884969
Regular
Aug 07, 2015

FERNANDO RUIZ-LUCERO vs. GCA SERVICES GROUP, INC.; ACE AMERICAN INSURANCE COMPANY, administered by ESIS FREMONT

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the finding that the applicant could treat outside the defendant's Medical Provider Network (MPN). The MPN failed to meet access standards by not having three primary treating chiropractors within a 15-mile or 30-minute radius of the applicant's residence. This failure constitutes good cause for the applicant to seek treatment outside the MPN, as required by regulations ensuring timely access to appropriate medical care. The Board agreed with the WCJ's reasoning that the defendant's inadequate MPN access justified the applicant's out-of-network treatment.

MPNAccess StandardsPrimary Treating PhysicianMedical Provider NetworkChiropractorAdministrative Director RuleWCJReconsiderationLabor CodeSpecialty
References
Case No. ADJ9145724
Regular
Jun 01, 2015

ARZAGA, JOSE vs. CROWN AUTOMOTIVE, INC., AMTRUST NORTH AMERICA

This case involves an applicant seeking to select a pain management specialist outside his employer's Medical Provider Network (MPN). The applicant argued the MPN failed to provide a qualifying specialist within the required 15-mile/30-minute access standard for a primary treating physician. The Board denied the employer's petition for reconsideration, affirming the applicant's right to choose an out-of-network physician and reimbursement for investigative costs. The majority reasoned that the MPN must meet the closer access standard for a primary treating physician, even if that physician is a specialist. A dissenting opinion argued that a specialist, when chosen as a primary treating physician, should fall under the 30-mile/60-minute access standard for specialists.

Medical Provider NetworkMPNprimary treating physicianpain management specialistaccess standardAdministrative Director's Rule 9767.5investigative costsLabor Code section 5703Lescallett v. Wal-MartMartinez v. New French Bakery
References
Case No. ADJ9618682
Regular
Sep 24, 2015

SOLEDAD GARCIA vs. LYONS MAGNUS, INC., AMERICAN ZURICH INSURANCE COMPANY, TRISTAR RISK MANAGEMENT

The applicant sought removal from a Workers' Compensation Appeals Board order that required her to treat within the defendant's Medical Provider Network (MPN). She argued the MPN lacked sufficient physiatrists, violating access standards, and sought to treat outside it. However, the Board denied removal, finding the applicant presented no evidence to support her claim that the MPN failed access standards or caused denial of treatment. The applicant failed to demonstrate significant prejudice or irreparable harm, and a lack of evidence was the primary impediment to her case.

Petition for RemovalMedical Provider Network (MPN)Access StandardsPrimary Treating Physician (PTP)PhysiatristPain ManagementPetition DenialFindings of Fact and Order (F&O)Workers' Compensation Appeals Board (WCAB)Rule 9767.5
References
Case No. ADJ9242655
Regular
Aug 22, 2014

Michelle Justus vs. Folsom-Cordova Unified School District

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration regarding treatment outside the Medical Provider Network (MPN). The WCJ correctly granted the applicant's motion to treat outside the MPN because the defendant failed to provide access within the required distance to the applicant's *present* workplace, not just the injury site. The Board affirmed that the term "workplace" in the regulation refers to the employee's current location of regular employment. Therefore, the defendant's argument that they met MPN access standards based on the former workplace was rejected.

Workers' Compensation Appeals BoardMPNPetition for ReconsiderationWCJ8 CCR section 9767.5(b)substantive rightliabilityinjury workplacepresent workplacegeographic location
References
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