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

Case No. ADJ7673518, ADJ7647749
Regular
Jan 23, 2015

ANA DE AYALA vs. AO-THE UNIVERSITY CORPORATION / CALIFORNIA STATE UNIVERSITY NORTHRIDGE

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior ruling, finding the applicant sustained industrial injury to her neck. While the applicant testified to injuring her neck in a workplace incident and this was partially corroborated, the Board found insufficient evidence for other claimed injuries. The Board specifically disagreed with the administrative law judge's credibility assessment concerning the neck injury itself, relying on medical reports and testimony supporting the neck injury claim. The Board affirmed the denial of claims for all other alleged injuries, finding insufficient medical evidence to link them to the incident.

Petition for ReconsiderationFindings and OrderIndustrial InjuryNeck InjuryBack InjurySpine InjuryUpper ExtremitiesPsycheGastroesophageal SystemInternal System
References
Case No. ADJ8026817
Regular
Apr 22, 2013

MARIA OCHOA vs. RANGERS DIE CASTING COMPANY, COMPWEST INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision finding the applicant sustained injury to her respiratory system and psyche AOE/COE. The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr. Lipper and Dr. Curtis lacked substantiality. Specifically, the physicians failed to provide clear diagnoses, quantify exposures, or adequately explain causation. The Board noted contradictory testimony from the applicant's supervisor and insufficient evidence to support the initial findings.

Workers' Compensation Appeals BoardMaria OchoaRangers Die Casting CompanyCOMPWEST INSURANCE COMPANYADJ8026817Los Angeles District OfficeOpinion and Order Granting ReconsiderationDecision After ReconsiderationFindings of FactWorkers' Compensation Administrative Law Judge (WCJ)
References
Case No. ADJ2460603 (OAK 0348588)
Regular
Aug 03, 2012

JOSE ROGER ABAN vs. CAL CENTURIAN CONSTRUCTION, INC. dba RWR CONSTRUCTION, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration to reverse a prior finding that a lien claimant was entitled to satisfaction of its lien. The Board found that while the defendant may have provided inadequate initial Medical Provider Network (MPN) notices, this deficiency did not result in the applicant being neglected or refused reasonable medical treatment. Because the applicant initially treated within the MPN and did not appear to have trouble accessing care due to the notices, the employer is not liable for self-procured treatment. Therefore, the lien claimant is not entitled to recover on its lien.

Workers' Compensation Appeals BoardMedical Provider Network (MPN)Self-procured medical treatmentLien claimantCompromise and ReleaseNeglect or refusal to provide medical treatmentFindings and OrdersPetition for ReconsiderationWCJReport and Recommendation
References
Case No. ADJ2401554 (FRE 023126)
Regular
Jan 07, 2013

JOSHUA GROSSMAN vs. ARAMARK UNIFORM SERVICE, ACE AMERICAN INSURANCE COMPANY

The Appeals Board granted reconsideration, reversing the judge's decision and finding the defendant liable for self-procured medical treatment. The defendant failed to prove they properly transferred the applicant into their Medical Provider Network (MPN) and neglected or refused to provide reasonable treatment by failing to ensure MPN physician availability. Consequently, the applicant's self-procured treatment from the lien claimant is deemed reasonable and compensable. The defendant is liable for the reasonable cost of this treatment, plus interest and penalties.

MPNself-procured medical treatmentneglect or refusal to provide medical treatmentprimary treating physicianlien claimantreasonable medical treatmentAramark Uniform ServiceAce American Insurance CompanySan Joaquin Accident & Medical GroupKnight v. Liberty Mut. Ins. Co.
References
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
Case No. AHM 127807, AHM 129147
En Banc
Oct 10, 2006

Bruce Knight vs. United Parcel Service, Liberty Mutual Insurance Company

The Appeals Board holds that an employer's failure to provide required notice of rights under a Medical Provider Network (MPN) constitutes a neglect or refusal to provide reasonable medical treatment, making the employer liable for reasonable medical treatment self-procured by the employee.

Medical Provider NetworkMPN noticeself-procured treatmentLabor Code 4600Labor Code 4616employer liabilityinsurer liabilityneglect or refusalreasonable medical treatmentemployee rights
References
Case No. ADJ7555799 (MF) ADJ7561888
Regular
Sep 08, 2017

REYNA PANIAGUA vs. T & R BANGI'S AGRICULTURAL SERVICES, INC., SEABRIGHT INSURANCE, administered by ENSTAR GROUP, STATE COMPENSATION INSURANCE FUND

This case involves an applicant seeking reconsideration of a finding that her employer did not refuse to provide medical treatment. The applicant's designated Medical Provider Network (MPN) physicians were unable to treat her, leading to delays and her eventual notification that a provider was no longer accepting new patients. Despite the applicant's frustration and inability to secure treatment within the MPN, the Board affirmed the original finding. The Board concluded there was insufficient evidence that the defendant neglected or refused to provide the requested medical treatment.

Workers Compensation Appeals BoardMedical Provider Network (MPN)Primary Treating Physician (PTP)Self-Procured TreatmentNeglect or Refusal to Provide TreatmentStipulations With Request for AwardCompromise and ReleaseExpedited HearingDeclaration of David KestnerCentral Valley Occupational Medical Group (CVO)
References
Case No. ADJ10369582
Regular
Nov 05, 2018

Barbara Riggs vs. Sears Holdings Corporation, ACE American Insurance Company

This case involves an applicant seeking workers' compensation benefits who claims she cannot find a physician within the defendant's Medical Provider Network (MPN) due to her deafness and past negative experiences. The Administrative Law Judge initially allowed out-of-network treatment based on "exceptional circumstances." However, the Appeals Board granted reconsideration to develop the record, finding that the primary issue is whether the defendant neglected or refused to provide reasonably necessary treatment within its MPN. The Board rescinded the prior order and returned the case for further proceedings to determine if the MPN physician can accommodate the applicant's needs and if the defendant's prior actions constituted neglect or refusal.

Workers' Compensation Appeals BoardSears Holdings CorporationACE American Insurance CompanyESISPetition for ReconsiderationFindings and OrdersMedical Provider Network (MPN)exceptional circumstancesself-procure medical treatmentLabor Code section 4600
References
Case No. ADJ10928385
Regular
Mar 05, 2018

MARCO GUERRERO vs. CITISTAFF SOLUTIONS, INC., OLD REPUBLIC INDEMNITY, GALLAGHER BASSETT

In this workers' compensation case, the defendant sought reconsideration of an award finding they failed to provide the applicant with required Medical Provider Network (MPN) notices after an admitted industrial injury. The applicant was found to be entitled to self-procure medical treatment at the defendant's expense due to this failure. The Workers' Compensation Appeals Board affirmed the original decision, holding the defendant failed to meet its burden of proving MPN notice compliance. The Board also agreed that the defendant's inadequate development of the record at trial did not warrant reopening and that the applicant's self-procured treatment was justified.

Medical Provider NetworkMPNpetition for reconsiderationneglect or refusalreasonable medical treatmentself-procured medical treatmentsubstantial medical evidencedue processdevelop the recorddenial of medical care
References
Case No. ADJ3425466 (FRE 0244904)
Regular
Mar 21, 2013

IMELDA SANCHEZ vs. COUNTY OF FRESNO

The Workers' Compensation Appeals Board affirmed the WCJ's finding that the County of Fresno neglected to provide adequate notice of the applicant's rights under its Medical Provider Network (MPN). This failure resulted in liability for the applicant's self-procured medical treatment from San Joaquin Accident and Medical Group. The Board found the defendant failed to prove proper initial MPN notification and subsequent transfer of care into the MPN. Therefore, the defendant is responsible for the reasonable costs of that treatment.

Workers' Compensation Appeals BoardMedical Provider NetworkMPNSelf-procured medical treatmentNeglect or refusalReasonable medical treatmentLabor Code section 4600Administrative Director Rule 9767.6Knight v. United Parcel ServiceBabbitt v. Ow Jing
References
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