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Case Law Database

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

Case No. ADJ10908349

Regular

Aug 07, 2018

BRANDON SELVITELLA vs. MARINWOOD COMMUNITY SERVICES DISTRICT

In this case, the applicant sought reconsideration of a decision that invalidated his predesignation of Dr. Stevenson as his primary treating physician. The Appeals Board denied the reconsideration petition. While acknowledging Kaiser's policy may hinder predesignation for its members, the Board upheld its decision based on the plain meaning of Labor Code section 4600(d)(2). The Board also considered the applicant's late-filed answer but found no grounds to overturn its prior ruling.

SelvitellaMarinwood Community Services DistrictYork Services GroupPetition for ReconsiderationPredesignationDr. StevensonPrimary Treating PhysicianLabor Code Section 5905Labor Code Section 4600(d)(2)Kaiser

References

Case No. ADJ12384017

Regular

Jan 31, 2020

WESLEY VAUGHN vs. THE KROEGER COMPANY dba RALPHS GROCERY COMPANY, SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

The Appeals Board granted reconsideration and rescinded the WCJ's finding that the applicant did not properly predesignate his physician. The Board determined that the sole issue presented to the WCJ was too narrowly framed, failing to address the applicant's arguments regarding substantial compliance and the defendant's alleged failure to provide proper notice of predesignation rights. The case is remanded for further proceedings to address the issues of proper notice and denial of care, which are crucial for determining treatment outside the Medical Provider Network.

PredesignationPrimary Treating PhysicianMedical Provider Network (MPN)Notice RequirementsDenial of CareSubstantial ComplianceThreshold IssueInterlocutory IssueRemoval StandardPetition for Reconsideration

References

Case No. ADJ10544145

Regular

Jun 03, 2019

WILLIAM FRANKLIN, JR. vs. SOLANO COUNTY - PROBATION DEPARTMENT

The Workers' Compensation Appeals Board granted reconsideration and deferred the issues of whether the applicant must treat within the defendant's Medical Provider Network (MPN) and whether the defendant properly followed the transfer of care procedure. The Board affirmed the finding that the applicant's predesignation of his orthopedic surgeon was not valid. Further proceedings are required to develop the record on the MPN and transfer of care issues before a final determination can be made.

Workers' Compensation Appeals BoardSolano County Probation DepartmentAthens AdministratorsPredesignation of Personal PhysicianMedical Provider Network (MPN)Administrative Director (AD) Rule 9767.9Continuity of CareTransfer of Care ProcedureQualified Medical Examiner (QME)Temporary Disability

References

Case No. ADJ7091667

Regular

Jan 31, 2013

THOMAS HERRERA vs. AMERI-COLD LOGISTICS, LIBERTY MUTUAL INSURANCE COMPANY

The Workers' Compensation Appeals Board reconsidered a decision allowing the applicant to treat outside the defendant's Medical Provider Network (MPN). The Board found the employer failed to notify the applicant of his right to predesignate a personal physician as required by law. However, the remedy for this failure is limited to treatment with that specific personal physician, not any physician outside the MPN. Therefore, the original order was rescinded, and the applicant is now entitled to treatment from his identified personal physician, Dr. Aceves, provided he meets the statutory criteria, and not outside the MPN otherwise.

ADJ7091667Americo LogisticsLiberty Mutual InsuranceMedical Provider Network (MPN)Petition for Reconsiderationcumulative injurypsyche injuryinternal injuryheadachessleep disorder

References

Case No. ADJ9749961

Regular

Oct 11, 2017

ROMEL MAAIA vs. REDNECK TRAILER SUPPLY, INC., NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURG, PA.

In this workers' compensation case, the Appeals Board granted reconsideration to address the applicant's entitlement to treat outside the defendant's Medical Provider Network (MPN). The defendant contested that the applicant's chosen physician, Dr. Shaw, qualified as a "regular physician" under Labor Code section 4600(d). Specifically, the defendant argued the applicant failed to prove the predesignation notice was submitted to the employer before the injury, and that Dr. Shaw was indeed the applicant's regular physician who retained his records. The Board found the record insufficient to definitively rule on these issues and remanded the case to the WCJ for further development of the evidence.

Predesignation of Personal PhysicianMedical Provider NetworkRegular PhysicianLabor Code section 4600Workers' Compensation Appeals BoardFindings of FactOpinion and Decision After ReconsiderationDevelop the RecordDue ProcessNimish Shah M.D.

References

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BRANDON SELVITELLA vs. MARINWOOD COMMUNITY SERVICES DISTRICT

WESLEY VAUGHN vs. THE KROEGER COMPANY dba RALPHS GROCERY COMPANY, SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

WILLIAM FRANKLIN, JR. vs. SOLANO COUNTY - PROBATION DEPARTMENT

THOMAS HERRERA vs. AMERI-COLD LOGISTICS, LIBERTY MUTUAL INSURANCE COMPANY

ADJ7091667Americo LogisticsLiberty Mutual InsuranceMedical Provider Network (MPN)Petition for Reconsiderationcumulative injurypsyche injuryinternal injuryheadachessleep disorder

ROMEL MAAIA vs. REDNECK TRAILER SUPPLY, INC., NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURG, PA.