CALIFORNIA COMPENSATION CASES Vol. 89, No. 7 July 2024 A Report of En Banc and Significant Panel Decisions of the WCAB and Selected Court Opinions of Related Interest, With a Digest of WCAB Decisions...
Havanis v. Calif. Dept. of Transportation (Board Panel Decision) By Hon. Colleen Casey, Former Commissioner, California Workers’ Compensation Appeals Board I. Medical apportionment is not the...
By Robert G. Rassp, author of The Lawyer’s Guide to the AMA Guides and California Workers’ Compensation (LexisNexis) Disclaimer: The material and any opinions contained in this treatise are...
Oakland, CA – Private self-insured claim volume in the California workers' compensation system fell 9.5% in 2023, producing the biggest year-to-year decline in private self-insured claim frequency...
By Hon. Susan V. Hamilton, Former Assistant Secretary and Deputy Commissioner, California Workers’ Compensation Appeals Board No matter the source of your media consumption, it seems that the topic...
A California WCAB panel recently held that while liens may be disallowed for medical treatment procured outside the defendant's Medical Provider Network, the applicant himself is not personally liable to the lien claimants pursuant to Labor Code § 4605 when he "did not intend" to self-procure medical treatment outside of the MPN. Given that the lien claimants are subject to the exclusive jurisdiction of the WCAB, it would appear that they would not have any avenue with which to recover so long as the applicant "did not intend" to self-procure.
In this case, the WCAB panel rescinded the WCJ's finding that applicant who sustained an industrial injury to his nose and low back self-procured medical treatment outside of defendant's MPN at his own expense pursuant to Labor Code § 4605, when the WCAB panel found that the WCJ incorrectly concluded that any and all medical treatment obtained outside of a properly noticed MPN is necessarily self-procured by an injured worker at his own expense pursuant to Labor Code § 4605, that the authority to determine if a bill is the injured worker's obligation under Labor Code § 4605 is different from exercising jurisdiction under Labor Code § 4903 to determine a lien against compensation based upon an employer's obligation to provide reasonable medical treatment, that the injured worker is only liable for medical treatment that he intended to self-procure at his own expense pursuant to Labor Code § 4605, and that here, while the record showed that the applicant obtained treatment outside the defendant's MPN, the evidence did not establish that he intended to do so at his own expense under Labor Code § 4605. See Mendez-Correa panel decision.
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