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PanelMed-legalLienGranted

Ambriz, Maricruz

MARICRUZ AMBRIZ, Applicant vs. JANICLEAN SERVICES, INC.; CYPRESS INSURANCE CO. administered by BERKSHIRE HATHAWAY, Defendants

ADJ number: ADJ17277232
Decision date: Feb 11, 2024
District office: Anaheim
WCJ: —
Claim administrator: Berkshire Hathaway (administering for Cypress Insurance Co.)
Commissioners: CRAIG SNELLINGS, COMMISSIONER, JOSÉ H. RAZO, COMMISSIONER, JOSEPH V. CAPURRO, COMMISSIONER

Injury / body parts: wrists, arms, back, right shoulder, feet, psyche/stress

LC §4600LC §4616LC §5705LC §3202.5LC §5708LC §5709LC §4060LC §4620LC §4064LC §5402LC §5903LC §5952

Summary

Lien claimant Medland Medical sought reconsideration of a February 12, 2024 F&O finding defendant not liable for applicant's self-procured medical treatment obtained outside the MPN. Applicant, a janitor, claimed a November 1, 2022 injury and was first seen by Dr. Haghighinia of Medland Medical on January 19, 2023, while he was outside defendant's MPN. The Board affirmed that the lien claimant failed to meet its burden under Labor Code section 4600 to prove neglect or denial of treatment justifying out-of-MPN self-procurement, noting applicant had admitted the existence of a valid MPN and had received MPN notices. However, the Board found the WCJ never addressed whether the January 19, 2023 report was compensable as a medical-legal evaluation, an issue distinct from treatment. The Board granted reconsideration, rescinded and substituted the F&O, and remanded for further development of the record on the medical-legal reimbursement issue.

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.

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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