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

Case No. ADJ9048259
Regular
Dec 30, 2015

Antonio Avila vs. Barrett Business Services, Inc., Corvel Insurance Company

Here's a summary of the case in four sentences for a lawyer: The Workers' Compensation Appeals Board denied reconsideration, upholding the judge's decision that the applicant must treat within the employer's Medical Provider Network (MPN). The Board found that while there were some informational deficiencies, they did not amount to a denial of medical treatment that would justify treating outside the MPN. Crucially, the applicant admitted he liked his MPN physician and only sought to change doctors based on his attorney's recommendation. Evidence showed the employer promptly provided medical treatment and confirmed the applicant's treating physician was within their MPN.

Workers' Compensation Appeals BoardPetition for ReconsiderationMPNMedical Provider NetworkWCJHealth First Medical GroupDr. Eliasattorney's recommendationBBSI MPNCorvel Insurance Company
References
Case No. ADJ9762825
Regular
Feb 29, 2016

MARIA OLGA BARAJAS vs. BARRETT BUSINESS SERVICES, CORVEL

This case involves Maria Olga Barajas's workers' compensation claim against Barrett Business Services and Corvel. The applicant was injured on July 20, 2014, and her attempts to change her treating physician within the employer's Medical Provider Network (MPN) were unsuccessful. The Workers' Compensation Appeals Board denied the defendants' Petition for Reconsideration, upholding the original award. This award allowed the applicant to seek treatment outside the MPN at the defendants' expense due to the failure to facilitate a timely change of physician.

Medical Provider NetworkMPNPetition for ReconsiderationFindings and Awardremovalchange of treating physicianinterim orderLabor Code § 4616.3(b)Title 8Regulations
References
Case No. ADJ3002639 (LAO 0881928)
Regular
Jun 11, 2012

MIGUEL NAVA vs. BARRETT BUSINESS SERVICES, INC.

This case concerns an applicant's industrial injury to his spine and knees. The defendant sought reconsideration of a decision that allowed reimbursement for non-MPN providers before November 28, 2008. The Appeals Board granted reconsideration, finding the applicant was bound to select an MPN physician as of his March 11, 2008 deposition stipulation. Therefore, non-MPN services rendered after March 11, 2008, are not compensable.

Workers' Compensation Appeals BoardMedical Provider NetworkMPNBarrett Business ServicesCorVel MPNLien ClaimantIndustrial InjurySpine InjuryKnee InjuryReconsideration
References
Case No. ADJ7897857
Regular
Feb 29, 2012

ALFONSO PONCE DE LEON vs. BARRETT BUSINESS SERVICES, CORVEL INSURANCE

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a trial judge's order allowing applicant treatment outside the defendant's Medical Provider Network (MPN). The WCAB found the judge improperly investigated the facts himself, violating judicial ethics. The evidence gathered by the judge did not definitively prove MPN non-compliance, and the judge failed to contact all listed physicians. Therefore, the case was returned for a new hearing where parties must present their own evidence regarding MPN physician availability.

MPNMedical Provider NetworkWorkers' Compensation Appeals BoardWCJReconsiderationAccess StandardsRegular PhysicianIndustrial InjuryOrthopedic SpecialistExpedited Hearing
References
Case No. ADJ10064259
Regular
Nov 19, 2015

, Applicant, CHARLES WAGNER, vs. , Defendants. BARRETT BUSINESS SERVICES; ACE AMERICAN INS. CO.; CORVEL ADMINSTRATOR

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior order allowing the applicant to treat outside the defendant's Medical Provider Network (MPN). The Board found that while MPN notice requirements are crucial, an employee can only treat outside the network at the employer's expense if a failure to provide notice resulted in a denial of medical care. In this case, the applicant received timely medical treatment, and the defendant presented evidence of providing MPN notices, thus, the applicant was not entitled to self-procured treatment outside the MPN.

Workers' Compensation Appeals BoardMedical Provider Network (MPN)ReconsiderationFindings and OrderAdministrative Law Judge (WCJ)Labor CodeRule 9767.12Medical TreatmentExpedited HearingForklift Operator
References
Case No. ADJ3823114 (MON 0252208)
Regular
Dec 03, 2015

ILANA BENLULU vs. BEVERLY SINAI TOWERS, SEDGWICK CLAIMS MANAGEMENT SERVICES, servicing facility for CIGA for RELIANCE INSURANCE COMPANY, in liquidation

This case concerns the proper transfer of an injured worker into a defendant's Medical Provider Network (MPN). The applicant contended she pre-designated her physician, avoiding MPN requirements, but provided no supporting evidence. The Board found that the defendant's prior attempts to transfer the applicant into the MPN were invalid due to insufficient notice or the MPN's failure to meet minimum access standards. Ultimately, the Board determined that a July 15, 2014 notice, properly served and containing all required information, effectively transferred the applicant into the MPN on August 14, 2014.

MPNMedical Provider NetworkReconsiderationFindings of FactWorkers' Compensation Appeals BoardLabor CodePre-designation of PhysicianContinuity of CareTransfer of CareMinimum Access Standards
References
Case No. ADJ9087890
Regular
Jul 03, 2018

SHERLENE WILLIAMS vs. GOLDEN EMPIRE TRANSIT, RISICO CLAIMS MANAGEMENT

This case concerns a lien claimant's claim for reimbursement following applicant Sherlene Williams' industrial injury as a bus driver. The Workers' Compensation Appeals Board affirmed the Administrative Law Judge's decision denying the lien because the medical provider was not within the defendant's Medical Provider Network (MPN). The majority found the WCJ correctly disallowed the lien due to non-compliance with MPN requirements. A dissenting opinion argued the record was incomplete regarding MPN notice to the applicant and recommended further development of evidence.

Medical Provider NetworkMPNLien ClaimantReconsiderationFindings and OrdersCompromise and ReleaseBurden of ProofMPN NoticeLabor Code Section 4616.3Administrative Director's Rule 9767.12
References
Case No. ADJ2359364 (FRE 0248119) ADJ4245839 (FRE 0248120) ADJ3951771 (FRE 0248121)
Regular
Feb 04, 2010

MARIA SOLANO DE SOTO vs. FOSTER FARMS

Lien claimants sought reconsideration after their claims were denied for providing medical services outside the defendant's Medical Provider Network (MPN). The Board denied reconsideration, affirming the original decision that services provided after the applicant received proper MPN notice were not compensable. Petitioners stipulated to the applicant's MPN notice and their own lack of MPN participation, undermining their claim that the defendant's notice was deficient. Ultimately, the petitioners failed to prove the defendant neglected or refused to provide reasonable medical treatment, a necessary element for self-procured treatment claims under *Knight*.

MPNMedical Provider NetworkKnight v. United Parcel Servicelien claimantsFindings and Awarddisallowed liensproper MPN noticeLabor Code sections 4613.1 and 4613.3Administrative Director Rule 9767.12(a)self-procured medical treatment
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. ADJ9028190
Regular
May 29, 2014

YE SUK KWAN KIM vs. B.C.D. TOFU HOUSE, INC., BERKSHIRE HATHAWAY on behalf of CYPRESS INSURANCE COMPANY

The Workers' Compensation Appeals Board affirmed a WCJ's decision finding applicant sustained industrial injury to her neck and upper extremities. The WCJ also ordered the employer to provide medical treatment outside the Medical Provider Network (MPN). Defendant sought reconsideration, arguing the WCJ erred in allowing out-of-MPN treatment despite proper notice, and in failing to rule on MPN transfer of care. The Board adopted the WCJ's report and denied the defendant's petition, affirming the original findings.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderIndustrial InjuryNeck InjuryUpper ExtremitiesMedical TreatmentMedical Provider NetworkMPNProper MPN Notices
References
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