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

Case No. ADJ3292672
Regular
Nov 08, 2012

SUSAN VIRDIER vs. CONCENTRA MANAGED CARE, ATLANTIC MUTUAL INSURANCE COMPANY (in liquidation), CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, TRAVELERS INDEMNITY INSURANCE COMPANY

This case concerns Travelers Indemnity Insurance Company's petition for reconsideration regarding its liability for applicant Susan Verdier's medical treatment. Travelers argued it should not be responsible for medical care in ADJ4661775, as it did not insure the employer at the time of the specific left wrist injury in ADJ3701452, and the cumulative trauma injury in ADJ4661775 involved different body parts. The Board denied the petition, holding that medical treatment expenses are not apportionable and that Travelers' coverage for the cumulative trauma period constitutes "other insurance" when the primary insurer is insolvent. The Board found no medical evidence distinguishing the need for treatment between the upper extremities and the wrist, thus upholding the finding that Travelers is available coverage for the award.

Workers Compensation Appeals BoardConcentra Managed CareAtlantic Mutual Insurance CompanyCalifornia Insurance Guarantee AssociationTravelers Indemnity Insurance CompanyreconsiderationFindings and Ordersother coveragemedical treatmentcumulative trauma
References
4
Case No. ADJ476925 (MON 0355919)
Regular
Jun 04, 2009

IRMA GUERECA vs. LSG SKY CHEFS, LIBERTY MUTUAL INSURANCE COMPANY

The Appeals Board granted reconsideration and rescinded a prior award, finding the record insufficient regarding MPN notice compliance. The case is returned to the trial level to determine if the employer provided proper MPN notice, whether any failure constituted a neglect or refusal to provide reasonable medical treatment, and if so, whether the applicant is entitled to self-procured treatment. Key factual issues to be developed include the date applicant stopped treating at Concentra and when MPN notice was provided, with a focus on statutory and regulatory compliance. The WCJ must issue a new decision after this record development.

MPNnotice requirementsself-procured medical treatmentneglect or refusalreasonable medical treatmentConcerta Clinicprimary treating physicianKnight v. United Parcel ServiceAppeals Board en bancLabor Code section 5705
References
2
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