CompFox Logo
AboutWorkflowFeaturesPricingCase LawInsights

Updated Daily

Case Law Database

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

Case No. ADJ8205235
Regular
Feb 06, 2013

HECTOR GOMEZ vs. FASTENAL, TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

This case concerns an injured worker, Hector Gomez, who sought medical treatment outside his employer's Medical Provider Network (MPN). The Board overturned the finding that the employer lost control of medical treatment, finding that the employer's technical failure to schedule the initial MPN visit did not deny treatment. The Board also held that the worker could not select a non-MPN specialist simply because an MPN specialist declined to act as a primary treating physician. Therefore, the applicant must obtain treatment through the defendant's MPN.

Workers' Compensation Appeals BoardMedical Provider Network (MPN)Primary Treating Physician (PTP)SpecialistLabor Code section 4616.3Administrative Director's Rule 9767.6initial medical evaluationchange of physicianforfeiture of medical controlaccess standards
References
1
Case No. ADJ7422993
Regular
Apr 06, 2015

SHIRLEY LESCALLETT vs. WAL-MART, ACE AMERICAN INSURANCE, YORK RISK SERVICES

In this workers' compensation case, the applicant sought to select a pain management specialist as her primary treating physician. The employer's Medical Provider Network (MPN) did not have any pain management specialists within the 15-mile/30-minute access standard for primary physicians, though it did have specialists within a 30-mile/60-minute radius. The Appeals Board affirmed the WCJ's decision, holding that if an applicant chooses a specialist for their primary care, the MPN must provide at least three physicians of that specialty within a 15-mile/30-minute radius. Since the defendant's MPN failed to meet this standard for pain management specialists, the applicant was permitted to choose one outside the MPN. A dissenting opinion argued that the 30-mile/60-minute standard for specialists should apply, allowing the applicant to select a physician within that broader radius from the MPN.

MPNMedical Provider NetworkPrimary Treating PhysicianSpecialistAccess StandardsAdministrative Director's RulePain Management PhysicianGeographic RadiusLabor CodeWorkers' Compensation Appeals Board
References
3
Case No. ADJ9145724
Regular
Jun 01, 2015

ARZAGA, JOSE vs. CROWN AUTOMOTIVE, INC., AMTRUST NORTH AMERICA

This case involves an applicant seeking to select a pain management specialist outside his employer's Medical Provider Network (MPN). The applicant argued the MPN failed to provide a qualifying specialist within the required 15-mile/30-minute access standard for a primary treating physician. The Board denied the employer's petition for reconsideration, affirming the applicant's right to choose an out-of-network physician and reimbursement for investigative costs. The majority reasoned that the MPN must meet the closer access standard for a primary treating physician, even if that physician is a specialist. A dissenting opinion argued that a specialist, when chosen as a primary treating physician, should fall under the 30-mile/60-minute access standard for specialists.

Medical Provider NetworkMPNprimary treating physicianpain management specialistaccess standardAdministrative Director's Rule 9767.5investigative costsLabor Code section 5703Lescallett v. Wal-MartMartinez v. New French Bakery
References
2
Case No. ADJ9052223
Regular
Aug 05, 2016

Joel Rodriguez Luna vs. The Home Depot, Helmsman Management

Here's a summary of the case for a lawyer in a maximum of four sentences: The Workers' Compensation Appeals Board denied Joel Rodriguez Luna's Petition for Removal, affirming the WCJ's finding that Home Depot's Medical Provider Network (MPN) complied with access standards. The WCJ determined that for a specialist, like an orthopedist, the MPN only needed to meet the 30-mile/60-minute access standard, not the stricter 15-mile/30-minute standard for a general primary treating physician. The Board agreed, concluding that since there was at least one orthopedic surgeon within the 30-mile radius, the MPN satisfied its obligations, despite the applicant's preference for a specialist within a closer distance. The dissenting opinion argued the MPN failed by not having at least three specialists readily available to serve as primary treating physicians for the applicant's specific orthopedic injuries.

Workers' Compensation Appeals BoardPetition for RemovalMedical Provider Network (MPN)Access StandardsPrimary Treating PhysicianSpecialistGeographic AreaAdministrative Director's RuleLabor CodeIndustrial Injury
References
3
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
2
Case No. ADJ3664982
Regular
May 13, 2009

CYNTHIA SALGADO vs. COUNTY OF ORANGE, SOUTHERN CALIFORNIA RISK MANAGEMENT ASSOCIATION

This case concerns whether medical reports from a physician outside the defendant's Medical Provider Network (MPN) were admissible and if the applicant should repay temporary disability benefits. The Appeals Board granted reconsideration, reversing the WCJ's exclusion of the non-MPN physician's reports and reinstating temporary disability benefits. The Board found the WCJ improperly rescinded prior rulings, and restitution was unwarranted as the applicant did not act fraudulently. The matter was remanded to determine the defendant's credit for payments made to the non-MPN physician.

Workers' Compensation Appeals BoardMedical Provider NetworkMPNAdmissibility of Medical ReportsReconsiderationRestitutionTemporary Disability IndemnitySelf-Procured Medical TreatmentLabor Code Section 4605Res Judicata
References
9
Case No. MISSING
Regular Panel Decision

Katz Park Avenue Corp. v. Jagger

Judge Ciparick issues a concurring opinion in an ejectment action, agreeing with the outcome of summary judgment against a tenant but dissenting from the majority's legal interpretation regarding the compatibility of B-1/B-2 visas and primary residency under New York's rent stabilization laws. Ciparick argues that while visa status can be a factor, it should not automatically disqualify a tenant from primary residency. The judge found that summary judgment was appropriately granted due to the tenant's unrebutted sporadic occupancy, lack of evidence of New York residency, and admissions of non-occupancy, establishing a prima facie case of non-primary residence, aligning with the rent stabilization law's goal of returning underutilized apartments to the market.

Rent StabilizationPrimary ResidenceB-2 VisaEjectment ActionSummary JudgmentNew York Rent LawImmigration StatusTenant OccupancyHousing LawConcurring Opinion
References
13
Case No. MISSING
Regular Panel Decision

MTA Bus Non-Union Employees Rank & File Committee ex rel. Simone v. Metropolitan Transportation Authority

The MTA Bus Non-Union Employees Rank and File Committee, along with fourteen individual plaintiffs, brought an action against the Metropolitan Transportation Authority (MTA) and MTA Bus Company (MTA Bus) concerning pension benefits. Plaintiffs asserted claims including violations of the Equal Protection Clauses of the United States and New York State Constitutions, two distinct breaches of contract, a violation of Section 115 of the New York Civil Services Law, and negligent misrepresentation. The court granted the defendants' motion for summary judgment on all claims and denied the plaintiffs' cross-motion for summary judgment. The court found that the pension benefit classifications had a rational basis, the contract claims were defeated by unambiguous plan documents, the Civil Services Law claim lacked jurisdictional basis, and the negligent misrepresentation claim was invalid as it was based on future promises.

Equal Protection ClauseRational Basis ReviewSummary JudgmentPension BenefitsBreach of ContractMTA Bus CompanyMetropolitan Transportation AuthorityNon-Union EmployeesNew York Civil Service LawNegligent Misrepresentation
References
24
Case No. ADJ11059073
Regular
Jan 17, 2023

SHERRILL CLAYTOR vs. ALEXANDER R. LATTERI, M.D., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) affirmed a prior decision allowing the applicant to treat with Dr. Spencer outside the defendant's Medical Provider Network (MPN). The WCAB found insufficient evidence that Dr. Spencer, or the applicant's previously selected physician Dr. Small, were definitively part of the defendant's MPN at the time of the request. Therefore, without proper MPN notification and an established denial of care, the applicant retained the right to resume treatment with her non-MPN physician, Dr. Spencer. The defendant may still attempt to transfer the applicant's care into the MPN by following proper statutory procedures.

MPNPTPmedical provider networkprimary treating physicianreconsiderationfindings and ordertransfer of caredenial of caresubstantial evidenceadministrative director rules
References
10
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
Showing 1-10 of 3,347 results

Ready to streamline your practice?

Apply these legal strategies instantly. CompFox helps you find decisions, analyze reports, and draft pleadings in minutes.

CompFox Logo

The AI standard for workers' compensation professionals. Faster research, deeper analysis, better outcomes.

Product

  • Platform
  • Workflow
  • Features
  • Pricing

Solutions

  • Defense Firms
  • Applicants' Attorneys
  • Insurance carriers
  • Medical Providers

Company

  • About
  • Insights
  • Case Law

Legal

  • Privacy
  • Terms
  • Trust
  • Cookies
  • Subscription

© 2026 CompFox Inc. All rights reserved.

Systems Operational