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

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. 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The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior order allowing the applicant to treat outside the defendant's Medical Provider Network (MPN).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. 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
1
Case No. ADJ8326077
Regular
Sep 20, 2018

JOSE RAMIREZ vs. LUCKY FARMS, INSURANCE COMPANY OF THE WEST

The Workers' Compensation Appeals Board granted reconsideration of a WCJ's order finding the defendant failed to prove a valid Medical Provider Network (MPN) and proper notice to the applicant. The Board rescinded the WCJ's decision and returned the case for further proceedings. The central issue is whether the defendant provided proper MPN notice and, if not, whether this failure resulted in a denial of medical care, justifying treatment outside the MPN. The Board emphasized that the defendant has the burden to prove proper notice, and lien claimants must then prove denial of care if notice was deficient.

Workers' Compensation Appeals BoardLucky FarmsInsurance Company of the WestADJ8326077Opinion and Order Granting Petition for ReconsiderationMedical Provider Network (MPN)Lien ClaimantsWCJFindings of Fact and OrderLabor Code section 4616.3
References
1
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. 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. ADJ6537779
Regular
Nov 29, 2010

FLORENCIO CASTANEDA vs. PICO RIVERA PALLET, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the original finding that the applicant was entitled to temporary disability benefits. The Board found the applicant's treating doctor's reports were substantial evidence and that the defendant failed to provide proper notice of the Medical Provider Network (MPN). Furthermore, the Board granted removal on its own motion and issued a notice of intention to sanction the defendant and its counsel for multiple violations of Board rules in their petition.

Workers' Compensation Appeals BoardPetition for ReconsiderationMedical Provider Network (MPN)Qualified Medical Examiner (QME)Temporary DisabilitySubstantial EvidenceNotice of IntentionSanctionsLabor Code section 5813Primary Treating Physician
References
8
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. ADJ4030941
Regular
Jan 21, 2011

SALVADOR CERDA vs. CHARTER OAK UNIFIED SCHOOL DISTRICT, YORK INSURANCE SERVICES GROUP

The Workers' Compensation Appeals Board denied the defendant school district's petition for reconsideration regarding applicant Salvador Cerda's medical treatment. The Board found that applicant's treatment with Dr. Paz was within the defendant's Medical Provider Network (MPN), rendering moot any arguments about the adequacy of the MPN notices. While Dr. Paz was listed in the MPN at a Los Angeles address, the Board held that the MPN agreement did not restrict treatment to that specific location or Tax ID. Therefore, the WCJ's determination that applicant was entitled to treat outside the MPN due to notice deficiencies was not reconsidered, as the treatment was deemed within the network.

MPNAD Rule 9767.12Labor Code section 3550Medical Provider NetworkWCJPetition for ReconsiderationWellCompCFMCTax IDlien claimant
References
3
Case No. ADJ7214982
Regular
Jan 06, 2012

JOAQUIN GONZALEZ vs. NFI INDUSTRIES, ZURICH AMERICAN INS. CO.

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration, upholding the WCJ's finding that the applicant received proper notice of the defendant's Medical Provider Network (MPN) and was treated within it initially. The Board also initiated sanctions against the applicant's attorney for misrepresenting witness testimony, threatening a $500 penalty unless good cause is shown otherwise. The applicant's arguments regarding non-MPN treatment non-compensability and inadmissibility of reports were rejected based on established precedent and findings of fact. The Board found the attorney's petition frivolous, demonstrating bad faith tactics.

MPNMedical Provider NetworkReconsiderationOrder of RemovalSanctionsLabor Code § 5813Bad Faith ActionsFrivolousWillful FailureImproper Motive
References
3
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