WCPanelIQ
PanelQMEDenied

Ruiz, Juan Carlos

JUAN CARLOS RUIZ, Applicant vs. McCARTHY BUILDING COMPANIES, INC., OLD REPUBLIC INSURANCE CORPORATION/BITCO, administered by GALLAGHER BASSETT SERVICES, INC., Defendants

ADJ number
ADJ16590361
Decision date
Date unavailable
District office
San Francisco
WCJ
Elizabeth Dehn
Claim administrator
Gallagher Bassett Services, Inc.
Commissioners
—

Injury / body parts: head, neck, cervical spine, upper back

LC §4600LC §4616LC §5902CCR §9767.5CCR §9767.6CCR §9785CCR §10940CCR §10945CCR §10972

Summary

Applicant Juan Carlos Ruiz sustained an admitted head injury (and claimed neck injury) on January 20, 2018 while working as a construction laborer. After designating multiple primary treating physicians within defendant's MPN over many months, applicant was unable to obtain actual treatment because authorized doctors were not accepting workers' compensation patients or were not at their listed locations. The WCJ found that while applicant failed to prove the MPN violated access standards, defendant neglected to provide medical treatment by never arranging an initial appointment despite knowing of applicant's difficulties, entitling applicant to treat outside the MPN at defendant's expense. The WCAB denied defendant's Petition for Reconsideration, adopting the WCJ's Report and Opinion, and also noted defendant's failure to cite to the record with specificity as an additional ground for denial under CCR section 10945.

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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