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

Case No. ADJ7849757
Regular
Jul 19, 2012

CRESCENCIO REYNOSO vs. V. TERRAZAS CONTRACTING, YORK CLAIMS SERVICES

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration. The Board affirmed the finding that the applicant, injured on January 7, 2011, must seek treatment within the employer's established and properly noticed Medical Provider Network (MPN). The applicant's arguments regarding MPN notification defects and the exclusion of evidence were found unmeritorious. The Board concluded the employer did not neglect or refuse to provide reasonably necessary medical treatment.

WCABADJ7849757Medical Provider NetworkMPNLabor Code 3550Labor Code 3551Labor Code 4600Labor Code 4616Self-Procured TreatmentAdministrative Director's Rules
References
Case No. ADJ8727749
Regular
Sep 26, 2013

CINDY VARGAS vs. SEARS HOLDINGS CORPORATION, SEDGWICK CMS

This case concerns an employer's petition to remove a WCJ's order compelling them to provide a complete list of their Medical Provider Network (MPN) in specific specialties. The employer argued this was overly burdensome, preferring to limit the list to providers within 30 miles of the applicant's residence. The Appeals Board denied removal, finding the WCJ's order was not burdensome or harassing under Administrative Director Rule 9767.12(f)(3). The Board noted the employer could fulfill the order electronically via CD or website, even if limited to the requested specialties.

Workers' Compensation Appeals BoardPetition for RemovalMedical Provider NetworkMPN listingTitle 8 Cal. Reg. § 9767.12(f)(3)Administrative Director Ruleregional area listingcomplete provider listingelectronic listingCD
References
Case No. ADJ1787217
Regular
Jul 27, 2011

OFELIA LLAMAS vs. SUN TEN LABORATORIES INC., ZENITH INSURANCE CO.

The Appeals Board denied a lien claimant's petition for reconsideration, upholding the disallowance of their liens for unauthorized treatment outside the Medical Provider Network (MPN). The lien claimant's arguments regarding defendant's denial of benefits and MPN notification failures were rejected, as the evidence showed timely MPN care was offered and the MPN notification issue was not raised at trial. The Board also initiated sanctions against the lien claimant's representative for filing a frivolous petition citing non-existent documents and outside evidence, finding this constituted bad faith and a waste of Board resources.

Workers' Compensation Appeals BoardLien ClaimantMPN providersunauthorized treatmentself-procure medical treatmentMPN employee notification requirementsCCR 9767.12reasonableness and necessityPetition for ReconsiderationOrder of Removal
References
Case No. ADJ6537787
Regular
Apr 08, 2013

LUIS RAMOS vs. WESTEND STAFFING SOLUTIONS, STATE COMPENSATION INSURANCE FUND

This case concerns a lien claimant, Long Beach Medical Center, whose petition for reconsideration was dismissed by the Workers' Compensation Appeals Board. The dismissal was based on multiple procedural deficiencies: the petition was skeletal, lacked a legally valid verification, and failed to provide proper proof of service on the defendant and other parties. The Board emphasized that failure to serve parties is a substantive omission, and an unverified petition also fails to meet statutory requirements. Therefore, the Board dismissed the petition for reconsideration.

Workers' Compensation Appeals BoardPetition for ReconsiderationDismissalLien ClaimantSkeletal PetitionLack of VerificationProof of ServiceWCJLabor Code section 5902Labor Code section 5903
References
Case No. LAO 0810946
Regular
Aug 16, 2007

ROBERT MARKOWITZ vs. BAKEAWAY BAKERY, CALIFORNIA INDEMNITY INSURANCE COMPANY, GAB ROBBINS NORTH AMERICA, INC.

The Workers' Compensation Appeals Board denied reconsideration of a decision that prevented the defendant from compelling the applicant to transfer to their Multiple Provider Network (MPN). The WCJ found that the defendant failed to provide proper notice of the MPN rights, which is a procedural prerequisite. Furthermore, even if proper notice were given, the un-rebutted medical evidence indicated the applicant should continue with their current treating physician.

Workers' Compensation Appeals BoardPetition for ReconsiderationMultiple Provider NetworkMPNAgreed Medical EvaluatorAMEFindings and OrderTemporary Total DisabilityTTDRule 9767.12
References
Case No. AHM 0144525
Regular
Dec 17, 2007

JOSE FUENTES vs. BORDERS GROUP, INC., LIBERTY MUTUAL INSURANCE COMPANY

This case concerns an applicant's petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision requiring him to treat within the defendant's Medical Provider Network (MPN). The WCAB denied the petition, adopting the administrative law judge's report. The key issue was whether a prior medical report indicating a "serious chronic condition" excused the applicant from MPN treatment, but this report was not properly submitted as evidence.

MPNMedical Provider NetworkPetition for ReconsiderationFindings Award and OrderWCJForklift OperatorThoracic SpineIndustrial InjuryNeck InjuryShoulder Injury
References
Case No. ADJ9466570
Regular
Dec 24, 2014

ELVIRA HERNANDEZ vs. NEWCO FOODS, INC., Operating As JACK IN THE BOX, SECURITY NATIONAL, Administered By AMTRUST NORTH AMERICA

The Workers' Compensation Appeals Board granted reconsideration to clarify an earlier decision regarding a Medical Provider Network (MPN). The Board affirmed the finding that the defendant failed to prove the existence of a valid MPN. Consequently, findings related to MPN access standards and transfer of care were rescinded, with the applicant permitted to continue treatment outside the invalid MPN with her chosen physician. This decision primarily hinges on the defendant's failure to establish a legally compliant MPN.

Medical Provider NetworkMPNFindings of Fact and AwardPetition for Reconsiderationprimary treating physiciantransfer of careself-procured medical treatmentTitle 8section 9767.5(b)Title 8
References
Case No. ADJ815719 (LAO 0886519)
Regular
Nov 04, 2011

MARTIN GRACIAN vs. BARRETT BUSINESS SERVICES

The Workers' Compensation Appeals Board granted reconsideration for a lien claimant challenging a judge's finding that the employer was not liable for medical treatment outside its Medical Provider Network (MPN). The Board found the judge failed to establish a proper evidentiary record, specifically by not admitting the employer's exhibits into evidence. Consequently, the Board rescinded the original decision and returned the case for further proceedings to create an adequate record to support any future determination regarding MPN applicability and notice.

MPNLien ClaimantReconsiderationFindings of FactEvidentiary RecordMedical Provider NetworkNotice of MPNLabor Code 4616Administrative Director Rule 9767.9Administrative Director Rule 9767.12
References
Case No. ADJ8890109 ADJ8890125
Regular
Jan 09, 2017

ELIZABETH BURGOS vs. IMAGEFIRST HEALTHCARE LAUNDRY SPECIALIST; TRAVELERS

The applicant sought removal from a Workers' Compensation Appeals Board decision finding no denial of care. The applicant argued a 43-day delay in authorizing a change to a new treating physician within the defendant's MPN constituted denial of care. The Board denied removal, finding the applicant did not prove denial of care, as there was no evidence of inability to obtain treatment or refusal by the defendant. Furthermore, the applicant's requested change of physician occurred after the initial 30-day window, thus not falling under Labor Code section 4601(a).

Workers' Compensation Appeals BoardPetition for RemovalJoint Findings and AwardStipulations with Request for AwardPrimary Treating Physician (PTP)Medical Provider Network (MPN)Denial of CareLabor Code section 4601(a)Labor Code section 4600Cal. Code Regs.
References
Case No. ADJ3814780
Regular
May 13, 2013

MARTIN VENEGAS vs. AMERICAN HONDA MOTOR COMPANY, SEDGWICK CMS

The Workers' Compensation Appeals Board denied reconsideration of an order dismissing liens. The liens were dismissed by operation of law for failure to timely pay the lien activation fee, and a Notice of Intention to Dismiss was unnecessary. The lien claimant's representative was present when the dismissal order was issued, but argued the petition was timely based on the defendant's proof of service. The Board adopted the WCJ's report, which found the lien claimant had notice and the petition for reconsideration was frivolous.

Lien Activation FeeOrder Denying ReconsiderationWorkers' Compensation Appeals BoardLien ConferenceDismissed by Operation of LawPetition for ReconsiderationAdministrative Law JudgeProof of ServiceLien ClaimantTimely Paid
References
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