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Case Law Database

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

Case No. ADJ6635537
Regular
May 06, 2011

EDDIE ESPINOZA vs. BARRETT BUSINESS SERVICES, INC.

This case involves a dispute over medical treatment network (MPN) compliance for an industrial back injury. The WCAB granted reconsideration to address whether the defendant's inadequate MPN notices led to a neglect or refusal to provide reasonable medical treatment, impacting the admissibility of outside medical reports. The Board will require the WCJ to re-evaluate MPN compliance and the propriety of further medical development. The case is returned to the trial level for further proceedings and a new decision consistent with the Board's opinion.

Workers' Compensation Appeals BoardMedical Provider Network (MPN)ReconsiderationFindings Award and OrderIndustrial InjuryMedical TreatmentTemporary DisabilityPermanent DisabilityApportionmentMedical Legal Process
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The Appeals Board granted reconsideration and rescinded a prior award, finding the record insufficient regarding MPN notice compliance.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
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The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a trial judge's order allowing applicant treatment outside the defendant's Medical Provider Network (MPN).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
0
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
6
Case No. ADJ11225851
Regular
Oct 18, 2019

SUZAN ELSHAMI vs. C & A RESTAURANTS INC.; SAFETY NATIONAL CASUALTY CORPORATION, administered by BROADSPIRE

This case involves an applicant challenging a WCJ's decision regarding a Medical Provider Network (MPN) issue. The Appeals Board granted reconsideration solely to amend the order vacating submission, instructing further record development without vacating submission. The Board affirmed the WCJ's finding of injury AOE/COE, a threshold issue, while deeming the MPN development order interlocutory. The Board clarified that for MPN compliance, the network only needs at least three available primary treating physicians of an appropriate specialty within access standards.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalVacating SubmissionFurther Development of RecordThreshold IssueFinal DecisionInterlocutory IssueInjury Arising Out of and in the Course of Employment (AOE/COE)Medical Provider Network (MPN)
References
7
Case No. ADJ6791157
Regular
May 12, 2011

NAIRA SHIRINYAN vs. MACY'S WEST, Permissibly Self-Insured

This case involves an applicant who sustained a work injury and disputes the defendant's compliance with medical provider network (MPN) requirements. The Appeals Board rescinded the WCJ's order that the defendant properly managed the MPN and did not owe for self-procured treatment. The Board returned the case to the trial level to address whether the defendant's MPN was properly established and approved by the DWC, and to address an issue regarding AD Rule 9767.12, which the WCJ had not decided. The applicant's argument about posting notices was waived as it was not raised at the mandatory settlement conference or trial.

Medical Provider NetworkMPNReconsiderationFindings and OrderMerchandising AssociateLabor Code SectionsDivision of Workers' CompensationDWCAdministrative DirectorAD Rule
References
4
Case No. MISSING
Regular Panel Decision

City Council v. Town Board

East-West Realty Corporation, owner of 37 acres in the Town of Colonie, sought to have its property, along with an additional 6 acres, annexed by the City of Watervliet to facilitate a senior citizen assisted-living development. The Town of Colonie denied the petition, citing non-compliance with the State Environmental Quality Review Act (SEQRA) and lack of overall public interest. The City of Watervliet, however, approved the petition and initiated a court proceeding to determine if the annexation was in the public interest, with East-West intervening as a petitioner. The Town of Colonie moved to dismiss the petition, arguing that Watervliet failed to comply with SEQRA prior to approving the annexation. The court found that annexation constitutes an 'action' subject to SEQRA review, even for parcels less than 100 acres, and that such review must occur at the earliest opportunity. Concluding that no SEQRA compliance occurred before the joint hearing, the court granted the Town of Colonie's motion and dismissed the petition.

annexationSEQRAenvironmental reviewzoning restrictionspublic interestmunicipal lawType I actionunlisted actionCPLR 404General Municipal Law
References
14
Case No. ADJ2247284 (MON 0356340) ADJ3324647 (MON 0356341) ADJ2374280 (MON 0356343) ADJ648207 (MON 0356344) ADJ476925 (MON 0355919)
Regular
Dec 08, 2008

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

The Workers' Compensation Appeals Board granted the defendant's petition for removal, rescinding an order to set the case for trial on all issues. The Board returned the matters to the trial level for an expedited hearing to determine if the applicant must obtain medical treatment within the employer's Medical Provider Network (MPN). This decision stems from an earlier order rescinding a previous findings and order, requiring further development of the record on specific notice compliance issues related to the MPN.

RemovalWorkers' Compensation Appeals BoardMedical Provider NetworkMPNLabor CodeAdministrative Director RuleExpedited HearingDue ProcessInterim Findings and OrderOpinion and Decision
References
1
Case No. ADJ7644740
Regular
Dec 19, 2011

MIGUEL GARCIA vs. G.D. HEIL, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded the previous Findings and Order because the applicant raised valid issues regarding the employer's compliance with Medical Provider Network (MPN) notice requirements and the admissibility of evidence. The WCAB found the initial determination on temporary disability and MPN validity lacked sufficient evidentiary support and noted a contradiction between the WCJ's initial findings and later report. The case is returned to the trial level for further proceedings to address these evidentiary and notice issues properly.

Workers' Compensation Appeals BoardMedical Provider Network (MPN)Temporary DisabilitySelf-Procured Medical TreatmentNotice RequirementsPre-Trial Conference StatementAdmissibility of EvidenceLabor Code Section 4600Labor Code Section 4616Administrative Director's Rule 9767.12(a)
References
6
Case No. ADJ8275808, ADJ8275842
Regular
Jun 27, 2016

MARIA NIETO vs. ERAUD FARMS, EA&T BERRY FARMS, ZENITH INSURANCE COMPANY

Lien claimants sought reconsideration of a decision disallowing their medical treatment liens, arguing applicant lacked proper notice of the employer's Medical Provider Network (MPN). The Appeals Board denied the petition, adopting the WCJ's reasoning. Applicant acknowledged receiving an MPN provider list, and the employer's certification of notice constitutes evidence of compliance absent contrary proof. Furthermore, even if notice was deficient, lien claimants failed to prove this failure led to a neglect or refusal of reasonable medical treatment.

MPN noticelien claimantspetition for reconsiderationmedical treatment liensself-procured medical treatmentKnight v. United Parcel ServiceTapia v. Skill Master Staffingworkers' compensationadministrative law judgeWCJ
References
2
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