ADJ17164621 · June 17, 2024

The record did not sufficiently establish that defendant neglected or refused medical treatment to applicant's non-admitted body parts, requiring further proceedings to determine if treatment outside the MPN is justified.

From the decision · page 1Defendant seeks removal in response to the Findings and Order (F&O) issued April 9, 2024, wherein the workers' compensation administrative law judge (WCJ) found that applicant, while employed as an electrician/plumber on August 9, 2022, sustained industrial injury to his right elbow, neck, right shoulder, right wrist, right hand and fingers. The WCJ found that defendant denied medical care to the applicant, allowing applicant to treat outside defendant's Medical Provider Network (MPN) at employer expense.

Defendant authorized initial platelet rich plasma injection and followed proper Utilization Review and Independent Medical Review processes for subsequent treatment requests.

Favours Defendant prevailed

This showed defendant did not neglect or refuse medically necessary treatment, undermining the claim of denial.

From the decision · page 5We acknowledge that the February 26, 2023 report of primary treating physician Dr. Mattar indicates that a prior request for platelet rich plasma injection had been denied. (Ex. 9, Report of Raafat Mattar, M.D., dated February 6, 2023, at pp. 3-4 [Bates pp. 63-64].) However, as per defendant's verified Petition, an initial request for a PRP injection was authorized by defendant on

Applicant testified that Dr. Mattar told him treatment for the neck was denied by defendants.

Favours Applicant prevailed

This testimony supported the WCJ's initial finding of denial of medical treatment, but the WCAB found the record insufficient to confirm denial.

From the decision · page 5The WCJ's Opinion on Decision notes applicant's trial testimony in which applicant testified that his complaints of injury upon initial evaluation extended beyond the right elbow and forearm, and included the neck shoulder, right wrist and hand. (Opinion on Decision, at p. 2.) Applicant further testified that primary treating physician Dr. Mattar told applicant that "treatment for the neck had been denied by the [d]efendants." (Ibid., citing Minutes, at p. 6:1.) The Opinion on Decision further cites to the February 6, 2023 report of Dr. Mattar, wherein the physician confirms that applicant was having neck pain, but that "he is only authorized to see me for the elbow." (Ex. 9, Report of Raafat Mattar, M.D., dated February 6, 2023, at pp. 3-4 [Bates pp. 63- 64].)

Dr. Mattar reported that applicant had neck pain but was only authorized to treat the right elbow; he told applicant that treatment for the neck had been denied by defendants.

The WCJ relied on Dr. Mattar's report and applicant's testimony to find defendant neglected or refused medical treatment to the neck, but the WCAB found the record insufficient to confirm denial of treatment.

From the decision · page 5The WCJ's Opinion on Decision notes applicant's trial testimony in which applicant testified that his complaints of injury upon initial evaluation extended beyond the right elbow and forearm, and included the neck shoulder, right wrist and hand. (Opinion on Decision, at p. 2.) Applicant further testified that primary treating physician Dr. Mattar told applicant that "treatment for the neck had been denied by the [d]efendants." (Ibid., citing Minutes, at p. 6:1.) The Opinion on Decision further cites to the February 6, 2023 report of Dr. Mattar, wherein the physician confirms that applicant was having neck pain, but that "he is only authorized to see me for the elbow." (Ex. 9, Report of Raafat Mattar, M.D., dated February 6, 2023, at pp. 3-4 [Bates pp. 63- 64].)

Labor Code section 4600

Labor Code section 4600 requires employer to provide all medical treatment reasonably required to cure or relieve effects of injury; neglect or refusal makes employer liable for self-procured treatment.

Applied to determine defendant's duty to provide medical treatment and whether neglect or refusal occurred.

From the decision · page 4Labor Code2 section 4600 requires that an employer or its insurer provide all medical treatment that is reasonably required to cure or relieve the injured worker from the effects of his or her injury. (Lab. Code, § 4600(a).) In the case of his or her neglect or refusal reasonably to do so, the employer is liable for the reasonable expense incurred by or on behalf of the employee in providing treatment. (Lab. Code, § 4600(a).) An employer will not be relieved of the duty to furnish medical care absent good cause, and section 4600 has been liberally interpreted in favor of the employee's right to obtain reimbursement. (California Union Ins. Co. v. Industrial Acc. Com. (Mitchell) (1960) 183 Cal.App.2d 644 [25 Cal.Comp.Cases 172]; Simien v. Industrial Acc. Com. (1956) 138 Cal.App.2d 397 [21 Cal.Comp.Cases 10]; Bobbitt v. Ow Jing dba National Market (2007) 72 Cal.Comp.Cases 70 [2007 Cal. Wrk. Comp. LEXIS 1] (Appeals Board en banc).)

Labor Code section 5705

Applicant bears burden to prove refusal or neglect of medical treatment to self-procure treatment outside MPN.

Applied to assign burden of proof to applicant on medical treatment refusal issue.

Administrative Director Rule 9767.9

If defendant neglects or refuses medical treatment, applicant may treat outside MPN at employer expense until transfer of care protocols are complied with.

Referenced for remedy if neglect or refusal is found in further proceedings.

From the decision · page 8and decision by the WCJ. Should the WCJ determine in subsequent proceedings that defendant has neglected or refused medical treatment to the applicant, applicant would be entitled to continue to treat outside defendant's MPN at employer expense until such time as the defendant has complied with the transfer of care protocols required by Administrative Director Rule 9767.9 (Cal. Code Regs., tit. 8, § 9767.9.)

Applicant's testimony that Dr. Mattar told him treatment for the neck was denied by defendants

From the decision · page 5The WCJ's Opinion on Decision notes applicant's trial testimony in which applicant testified that his complaints of injury upon initial evaluation extended beyond the right elbow and forearm, and included the neck shoulder, right wrist and hand. (Opinion on Decision, at p. 2.) Applicant further testified that primary treating physician Dr. Mattar told applicant that "treatment for the neck had been denied by the [d]efendants." (Ibid., citing Minutes, at p. 6:1.) The Opinion on Decision further cites to the February 6, 2023 report of Dr. Mattar, wherein the physician confirms that applicant was having neck pain, but that "he is only authorized to see me for the elbow." (Ex. 9, Report of Raafat Mattar, M.D., dated February 6, 2023, at pp. 3-4 [Bates pp. 63- 64].)

Defendant's verified Petition showing authorization and denial process for platelet rich plasma injections

From the decision · page 5We acknowledge that the February 26, 2023 report of primary treating physician Dr. Mattar indicates that a prior request for platelet rich plasma injection had been denied. (Ex. 9, Report of Raafat Mattar, M.D., dated February 6, 2023, at pp. 3-4 [Bates pp. 63-64].) However, as per defendant's verified Petition, an initial request for a PRP injection was authorized by defendant on