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PanelMed-legalLienGranted in Part

Wei, Qing Zhong

QING ZHONG WEI, Applicant vs. GRAND OAK TREE, LLC.; INSURANCE COMPANY OF THE WEST, Defendants

ADJ number: ADJ13323913
Decision date: Dec 15, 2024
District office: Los Angeles
WCJ: —
Claim administrator: Insurance Company of the West (ICW Group)
Commissioners: KATHERINE A. ZALEWSKI, CHAIR, JOSEPH V. CAPURRO, COMMISSIONER, CRAIG SNELLINGS, COMMISSIONER

Injury / body parts: left shoulder, left side rib cage, lumbar spine, left sacroiliac joint, right sacroiliac joint

LC §4906LC §5909LC §5900LC §5702LC §4600LC §4616LC §4616.3LC §4622CCR §10600CCR §10700CCR §9767.12CCR §9767.5

Summary

Lien claimant Optimal Health Medical Center sought reconsideration of a WCJ's F&O finding that defendant maintained a valid MPN and properly controlled medical treatment, so that the lien claimant's services were not reasonably required. Applicant was injured on April 2, 2020, became represented April 7, 2020, and treated with Dr. Andrew Shen (a non-MPN physician) beginning July 1, 2020. Defendant's MPN notice (the April 9, 2020 letter designating Kaiser Permanente) was never served on applicant's attorney, was limited to certain body parts, and the denial letter to Dr. Shen was not faxed until July 6, 2020—after the July 1, 2020 evaluation. The Board found defendant's notice deficient, making defendant liable for self-procured treatment until applicant's August 6, 2020 stipulation that a valid MPN existed. The Board granted reconsideration and amended the F&O to hold defendant liable for the cost of medical treatment and medical-legal services up to August 6, 2020.

Issues

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Holding

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Analysis

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Applicant takeaway

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Defense takeaway

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Provider takeaway

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Similar decisions

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Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

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