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

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
0
Case No. SDO 0360376
Regular
Jul 29, 2008

RAUL VIGIL PERALTA vs. NEW VISION PRESTIGE REAL ESTATE, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration, upholding the administrative law judge's decision that the defendant provided adequate notice of its Medical Provider Network (MPN). The applicant argued that insufficient notice should have resulted in a permanent waiver from the MPN, but the Board found that the applicant and his attorney received sufficient notice, including a guidebook and awareness of the option to select MPN physicians. Therefore, the applicant is required to treat within the defendant's MPN as of the date adequate notice was provided.

Medical Provider NetworkMPN noticepermanent waiveradequate noticepre-designate physiciancompensable consequenceindustrial injurypetition for reconsiderationAmended Findings and AwardWCJ
References
0
Case No. ADJ8128004
Regular
Nov 28, 2017

GLADYS PATINO vs. ABBOTT LABORATORIES, INC./ABBOTT VASCULAR, INC., TRAVELERS PROPERTY CASUALTY COMPANY of AMERICA

The Workers' Compensation Appeals Board granted reconsideration and rescinded the original findings regarding the applicant's requirement to seek treatment within the employer's Medical Provider Network (MPN). The Board found that the employer's MPN notice may not have complied with the bilingual notice requirement under California regulations. Therefore, the issue of treatment outside the MPN was deferred, and the case was returned to the WCJ for further proceedings to develop the record on this issue.

Workers' Compensation Appeals BoardMedical Provider NetworkMPN NoticeContinuity of CarePetition for ReconsiderationFindings of FactWCJNotice of DenialPrimary Treating PhysicianDue Process
References
5
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
1
Case No. MISSING
Regular Panel Decision

Matter of Logan v. New York City Health & Hospital Corp.

The claimant, a medical surgery technician, initially reported a left knee injury after slipping on a wet floor on November 25, 2010. Nearly a year later, in September 2011, she filed a claim for additional injuries to her right knee, neck, back, and bilateral shoulders resulting from the same incident. A Workers' Compensation Law Judge initially disallowed these additional claims due to lack of timely written notice as per Workers’ Compensation Law § 18. However, both a Board panel and the full Workers’ Compensation Board subsequently excused the claimant's late notice, interpreting the statute to require employer knowledge of the accident, not each specific injury. The self-insured employer appealed, contending that "knowledge of the accident" should be construed as "knowledge of the injury," but the court affirmed the Board's decision, upholding the plain meaning and distinct statutory usage of "accident" and "injury."

Workers' CompensationNotice of InjuryTimely NoticeEmployer KnowledgeAccident vs. InjuryStatutory ConstructionPlain Meaning RuleLegislative IntentNew York LawAppellate Division
References
13
Case No. ADJ7236056
Regular
Jul 21, 2011

KAREN MARTIN vs. MANPOWER, INC., GALLAGHER BASSETT SERVICES, INC.

This case concerns an applicant who sustained a left knee and back injury but also claimed injury to her neck and left shoulder. The applicant petitioned for reconsideration of an order requiring her to treat within the Medical Provider Network (MPN), alleging the MPN notice was defective due to its provision method and delayed list. The Board denied the petition, adopting the WCJ's reasoning that while there were initial MPN notice defects, they were corrected and do not exempt the applicant from MPN treatment. While acknowledging concern over the delay in providing a usable MPN list, the Board found no authority to overturn the original order.

Workers' Compensation Appeals BoardManpower Inc.Gallagher Bassett Services Inc.MPNMedical Provider Networkdefective noticeexpedited hearingFindings and OrderPetition for ReconsiderationWCJ
References
0
Case No. MISSING
Regular Panel Decision
Nov 25, 1997

Mark v. Board of Education

The Supreme Court, Kings County, denied the petitioners' application for leave to serve a late notice of claim, an order which was subsequently affirmed on appeal. The appellate court found no improvident exercise of discretion in the denial. The petitioners failed to provide a legally acceptable excuse for their almost six-month delay beyond the 90-day statutorily-prescribed period. Additionally, the petitioners did not provide the respondents with actual notice of the essential facts of the claim within the required timeframe. The court noted that the conditions at the accident scene changed to the prejudice of the respondents, preventing their own investigation, and the ladder involved was allegedly discarded immediately after the incident. Filing a Workers’ Compensation claim was also deemed insufficient to satisfy the notice requirements of General Municipal Law § 50-e.

late notice of claimjudicial discretionactual noticeprejudice to respondentchanged conditionsWorkers’ Compensation claimappellate reviewstatutory periodKings Countymunicipal liability
References
8
Case No. ADJ551158 (MON 0363400)
Regular
Jul 09, 2010

HELEN B. JAKES, HELEN JAKES ELAM vs. STATE OF CALIFORNIA; DEPARTMENT OF CORRECTIONS, CIM, Legally Uninsured

This case involves the State of California and the Department of Corrections seeking reconsideration of a Workers' Compensation Appeals Board decision. The Board found the employer failed to properly notify the employee of its Medical Provider Network (MPN), making them liable for self-procured medical treatment. However, the Board reversed this, finding that subsequent notices from the employer did sufficiently inform the employee about the MPN. Therefore, the employee is now required to seek treatment within the employer's MPN, and the employer is not liable for self-procured treatment after the date of the subsequent notice.

Medical Provider NetworkMPNSelf-Procured Medical TreatmentNotice RequirementsLabor Code Section 4616.3Administrative Director's Rule 9767.12(a)Due ProcessJoint Findings and AwardPetition for ReconsiderationReturn to Work Coordinator
References
3
Case No. ADJ7942487
Regular
Sep 14, 2012

PEDRO SANCHEZ MARTINEZ vs. STEVENS TRANSPORTATION, INC., TRAVELERS INSURANCE CO.

This case involves an applicant truck driver who sustained industrial injuries and sought self-procured medical treatment outside his employer's Medical Provider Network (MPN). The applicant claimed the employer failed to meet MPN notice requirements, making them liable for his treatment costs. However, the Board affirmed the trial judge's decision, finding the employer provided adequate MPN information via a bilingual letter and signed acknowledgment, despite the applicant's claims of not recalling the notice. Therefore, the employer was not found liable for the applicant's self-procured treatment.

Workers' Compensation Appeals BoardPetition for ReconsiderationIndustrial InjuryMedical Provider Network (MPN)Self-Procured TreatmentPosting and Notice RequirementsLabor Code § 4605Labor Code § 4600(a)Consulting PhysicianAttending Physicians
References
2
Case No. ADJ6610233
Regular
Nov 18, 2014

WILLIAM WILLIAMS (Deceased) vs. STATE OF CALIFORNIA, CDCR - PLEASANT VALLEY STATE PRISON, Legally Uninsured; STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES, Adjusting Agency

This case concerns a deceased correctional officer whose dependent sons were awarded death benefits. The Appeals Board denied reconsideration of its prior order requiring an offset for a CalPERS special death benefit received by the decedent's widow, deeming it consistent with precedent and statutory intent. The Board also issued a notice of intention to disallow the applicant's attorney's requested fee increase due to non-compliance with a rule regarding notice to the client of adverse interests. Compliance with this rule is required for the fee increase to be considered by the trial judge.

CalPERSspecial death benefitoffsetdeath benefitsdependent childrenattorney's feesWCAB Rule 10778adverse interestindependent counselPetiton for Reconsideration
References
4
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