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

Case No. ADJ8331259
Regular
Dec 21, 2012

MARIELA GOMEZ vs. PROVIDENCE FARMS, LLC, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the defendant's Petition for Reconsideration. The Board adopted the WCJ's report, emphasizing that the defendant's failure to properly notify the applicant about changing treating physicians within the Medical Provider Network (MPN) resulted in a denial of necessary medical treatment. This failure to inform the applicant of her rights, particularly regarding physician selection and dispute resolution processes within the MPN, constituted a neglect or refusal to provide reasonable medical treatment, as established by precedent. Consequently, the applicant was permitted to continue receiving treatment outside the MPN until she could begin care with a designated physician within the network.

Workers' Compensation Appeals BoardProvidence FarmsLLCZenith Insurance CompanyMariela GomezADJ8331259Order Denying ReconsiderationPetition for ReconsiderationMedical TreatmentMedical Provider Network
References
2
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
2
Case No. MISSING
Regular Panel Decision

In re Samuel DD.

Respondent appealed a Family Court order from Albany County, entered April 20, 2010, which adjudicated her child, Samuel DD., neglected under Family Ct Act article 10. The neglect finding stemmed from respondent's failure to provide necessary medical treatment for the child's severe behavioral and mental health issues, including ADHD and suspected bipolar disorder, along with educational neglect and respondent’s own mental health problems. The child exhibited extreme and dangerous behaviors at school, leading to his dismissal. Despite medical recommendations for medication and psychiatric evaluation, the respondent refused to administer treatment, attend follow-up appointments, or cooperate with service plans. The appellate court affirmed the neglect finding, concluding that the record provided ample evidence of respondent's unreasonable failure to exercise a minimum degree of care in providing for the child's welfare.

Child NeglectFamily Court ActParental RightsMedical Treatment RefusalChild Mental HealthADHDBehavioral IssuesEducational NeglectAppellate ReviewParental Care Standards
References
11
Case No. AHM 127807
Significant
Oct 10, 2006

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

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

Medical Provider NetworkMPN noticeself-procured treatmentemployer liabilityduty to notifyLabor Code section 4600neglect or refusalreasonable medical treatmenten banc decisionworkers' compensation
References
18
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
18
Case No. ADJ15777619, ADJ15777625
Regular
Oct 13, 2025

VIRGINIA GALVAN vs. REGIONAL CENTER OF ORANGE COUNTY, INC.; CYPRESS INSURANCE COMPANY

Defendant sought reconsideration of the Joint Findings and Order issued on August 12, 2025, which found applicant sustained an employment-related injury and could self-procure treatment outside the defendant's medical provider network (MPN). Defendant contended the applicant failed to establish a neglect or refusal to provide reasonable medical care and that the WCJ's order allowing treatment outside the MPN was unsupported. The Appeals Board, after considering the petition, answer, and the WCJ's report, denied reconsideration. The Board adopted and incorporated the WCJ's findings that defendant failed to provide evidence of a valid MPN, proper notices, or treatment within the MPN, thereby constituting a denial of medical care and allowing the applicant to treat outside the MPN.

Workers' Compensation Appeals BoardPetition for ReconsiderationJoint Findings and OrderMedical Provider Network (MPN)Self-Procure TreatmentNeglect or Refusal to TreatAdverse InferencePre-Trial Conference Statement (PTCS)Discovery ClosureMandatory Settlement Conference (MSC)
References
12
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. ADJ7532078
Regular
Mar 06, 2013

JESUS GONZALEZ vs. HERMAN WEISKER, INC., NATIONAL UNION FIRE INSURANCE, CHARTIS

The Appeals Board affirmed the WCJ's finding that applicant sustained a head and neck injury and that treatment outside the employer's medical provider network (MPN) was improper. While the employer failed to provide proper MPN notice, the applicant did not demonstrate this failure resulted in neglect or refusal to provide reasonable medical treatment. Therefore, treatment outside the MPN was not authorized. The Board found no error in the WCJ's decision.

Workers' Compensation Appeals BoardMedical Provider NetworkMPNLabor Code section 4616.3Findings of FactReconsiderationWCJPetition for ReconsiderationReport and RecommendationKnight v. United Parcel Service
References
1
Case No. ADJ6958632
Regular
Jun 16, 2010

CRUSTINA MEDRANO vs. LOS ALTOS FARMS, LLC, ZENITH

The Appeals Board granted Zenith Insurance's petition for reconsideration, reversing the WCJ's award of self-procured medical treatment. The Board found that the applicant received proper notification of Zenith's Medical Provider Network (MPN) at the time of her injury. Furthermore, the Board determined that the applicant knew or should have known she was being treated within the MPN and that any alleged lack of notice did not result in a neglect or refusal to provide reasonable medical treatment. Therefore, the applicant is not entitled to reimbursement for self-procured treatment outside the MPN.

MPNMedical Provider NetworkreconsiderationFindings Award and OrderZenith Insurance CompanyLabor Code section 4600self-procured medical treatmentKnight v. United Parcel Servicenotice requirementsneglect or refusal
References
2
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
3
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