WCPanelIQ
PanelQMEMed-legalLienDenied

Suarez, Armando

ARMANDO SUAREZ, Applicant vs. PAYNES JANITORIAL SERVICES INC.; CYPRESS INS. COMPANY, C/O BERKSHIRE HATHAWAY, Defendants

ADJ number
ADJ11347585
Decision date
May 9, 2024
District office
San Bernardino
WCJ
Tracy L. Hughes
Claim administrator
Cypress Insurance Company, c/o Berkshire Hathaway
Commissioners
—

Injury / body parts: right foot, right ankle

LC §4062LC §4610LC §4610.5LC §4620LC §4622CCR §10620

Summary

RMS Medical, a lien claimant, sought reconsideration of an Amended Findings and Order that denied reimbursement for medical treatment and medical-legal services. The applicant, Armando Suarez, suffered a right foot/ankle injury on October 30, 2017, and received treatment within the defendant's MPN from Concentra through podiatrist Dr. Haupt and orthopedist Dr. Piasecki until reaching permanent and stationary status on March 29, 2019. The lien claimant argued the defendant neglected to provide reasonable medical treatment by denying an MRI through utilization review, justifying self-procurement of non-MPN treatment with Dr. Gottschalk. The WCJ found that the applicant was timely provided MPN treatment, that a UR denial of a specific treatment protocol does not constitute refusal/neglect under Knight v. UPS, and that Dr. Gottschalk's reports did not qualify as medical-legal expenses under Labor Code 4620. The WCAB adopted and incorporated the WCJ's Report and denied reconsideration.

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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