ADJ8051313 · September 15, 2023

The lien claimant failed to meet the burden of proof to show that the defendant neglected or refused to provide reasonably necessary medical treatment outside the MPN. The applicant had stipulated to treat within the MPN at hearings, and no evidence was presented to show denial of care by the defendant.

From the decision · page 1We have considered the allegations of the Petition for Reconsideration and the contents of the report of the workers' compensation administrative law judge (WCJ) with respect thereto. Based on our review of the record, and for the reasons stated in the WCJ's report, which we adopt and incorporate, and for the reasons discussed below, we will deny reconsideration.

Applicant stipulated to treat within the Medical Provider Network at two Expedited Hearings.

Favours Defendant prevailed

This demonstrated applicant's agreement to treat within the MPN, undermining the claim for treatment outside the MPN.

From the decision · page 5The court found the actions of the applicant demonstrated an acknowledgement and agreement to treat within the Medical Provider Network of defendants as evidenced by applicant's stipulations at Expedited Hearings on March 5, 2012 and August 28, 2012.

No testimony or evidence was presented to show denial or refusal of medical treatment by defendant.

Favours Defendant prevailed

Without evidence of denial or refusal, the lien claimant failed to meet the burden of proof for treatment outside the MPN.

From the decision · page 5The burden of proof to establish a right to treatment outside of the MPN rested on the lien claimant. The lien claimant produced no testimony to support their position. There was no evidence to support lien claimant's assertion that defendant denied medical treatment. To the contrary, the applicant was treated within the Medical Provider Network prior to representation by counsel, and despite stipulating to treat within the MPN on March 5, 2012, the applicant began treatment outside the MPN on April 26, 2012.

Provided treatment to applicant outside the MPN from April 26, 2012 to August 17, 2012, which was objected to by defendant as outside the MPN.

Treatment by Dr. Nia was outside the MPN and objected to by defendant, relevant to the dispute over entitlement to treatment outside the MPN.

Labor Code section 4600

Labor Code section 4600 requires the employer to provide reasonable medical treatment to cure or relieve from the effects of an industrial injury.

Employer must provide treatment within MPN unless neglect or refusal to provide treatment is shown.

From the decision · page 1Labor Code section 4600 requires the employer to provide reasonable medical treatment to cure or relieve from the effects of an industrial injury. (Lab. Code, § 4600(a).) If an employer has established an MPN, an injured worker is generally limited to treating with a physician from within the employer's MPN. (Lab. Code, § 4600(c), 4616 et seq.) However, if the employer neglects or refuses to provide reasonably necessary medical treatment, whether through an MPN or otherwise, then an injured worker may self-procure medical treatment at the employer's expense. (Lab. Code, § 4600(a); see also McCoy v. Industrial Acc. Com. (1966) 64 Cal.2d 82, 87 [31 Cal.Comp.Cases 93] ["the employer is required to provide treatment which is reasonably necessary to cure or relieve the employee's distress, and if he neglects or refuses to do so, he must reimburse the employee for his expenses in obtaining such treatment"].)

Labor Code section 5705 and 3202.5

The burden of proof rests upon the party with the affirmative of the issue, by a preponderance of the evidence.

Lien claimant must prove entitlement to treatment outside MPN by preponderance of evidence.

From the decision · page 1The burden of proof rests upon the party with the affirmative of the issue. (Lab. Code, § 5705.) All parties shall meet the evidentiary burden of proof on all issues by a preponderance of the evidence. (Lab. Code, § 3202.5.) In a matter where an injured worker seeks entitlement to

Labor Code section 4603.2(a)(3)

If the employer objects to the employee's selection of a physician outside the MPN and there is a final determination that the employee was not entitled to select a physician outside the MPN, the employer has no liability for treatment provided outside the MPN.

Employer not liable for treatment outside MPN if final determination denies entitlement.

From the decision · page 5Pursuant to Labor Code Section 4603.2(a)(3): If the employer objects to the employee's selection of the physician on the grounds that the physician is not within the medical provider network used by the employer, and there is a final determination that the employee was not entitled to select a physician outside the medical provider network, the employer shall have no liability for treatment provided by or at the direction of that physician or for any consequences of the treatment outside the network.

Applicant stipulated to treat within the Medical Provider Network at Expedited Hearings on March 5, 2012 and August 28, 2012.

From the decision · page 5The court found the actions of the applicant demonstrated an acknowledgement and agreement to treat within the Medical Provider Network of defendants as evidenced by applicant's stipulations at Expedited Hearings on March 5, 2012 and August 28, 2012.