What the panel ordered
The WCAB affirmed the WCJ's Findings and Order, allowing applicant to treat with Dr. Curtis Spencer as her primary treating physician (PTP) outside of defendant's MPN, subject to defendant's future compliance with transfer of care provisions.
Defendant sought reconsideration of the WCJ's Findings and Order issued on February 9, 2021, which permitted applicant to treat with Dr. Curtis Spencer outside of defendant's medical provider network (MPN). The WCJ recommended denial of defendant's petition for reconsideration.
What was disputed, and how it came out
Each issue the panel decided, with the reasoning it gave. An outcome is what this panel did on this record — not a rule, and not a prediction.
The evidence showed applicant treated with a non-MPN physician, Dr. Spencer, for years and continued after selecting Dr. Small as PTP. There was no substantial evidence that Dr. Small was in the MPN or that applicant was treating within the MPN when requesting Dr. Spencer as PTP again. Defendant did not object to the request. Therefore, applicant was entitled to treat with Dr. Spencer outside the MPN.
From the decision · page 7Defendant argues that applicant was brought back into the MPN when she selected Dr. Small as her PTP and thus, she may not now choose a non-MPN physician absent a denial of care. We agree that the evidence does not indicate a denial of care by defendant. Instead, the evidence shows that applicant treated with a non-MPN physician for years and continued to treat with Dr. Spencer after she began treating with Dr. Small. If Dr. Small is a member of defendant's MPN (whether the old or new MPN), there may be a viable argument that applicant voluntarily returned herself to the MPN by selecting Dr. Small as her PTP and she may not now choose a PTP outside the MPN absent a denial of care. However, this conclusion presumes that Dr. Small is actually in the MPN, a fact that applicant has not conceded and is not supported by substantial evidence in the record. (See Hamilton v. Lockheed Corp. (Hamilton) (2001) 66 Cal.Comp.Cases 473, 476 (Appeals Board en banc) [decisions of the Appeals Board "must be based on admitted evidence in the record"].) We do not presume Dr. Small is in the MPN based solely on defendant's assertion that he is a member of it.