WCPanelIQ
PanelDenied

Jose Ortega — ADJ11073181

JOSE ORTEGA, Applicant vs. SEGALE AND CERINI, INC.; WESCO INSURANCE CO., administered by AMTRUST, Defendants

ADJ number
ADJ11073181
Decision date
Mar 29, 2022
District office
San Francisco
WCJ
—
Claim administrator
AmTrust (administering Wesco Insurance Co.)
Commissioners
KATHERINE A. ZALEWSKI, CHAIR, KATHERINE WILLIAMS DODD, COMMISSIONER, DEIDRA E. LOWE, COMMISSIONER
LC §5904CCR §10955

Summary

Defendant Segale and Cerini, Inc. (insured by Wesco Insurance Co., administered by AmTrust) petitioned for reconsideration of the WCJ's January 12, 2022 Findings & Award & Order, challenging the determination that applicant Jose Ortega could treat outside of defendant's Medical Provider Network (MPN). The Board observed that the decision was a hybrid order: it contained a final threshold finding on injury AOE/COE but defendant only disputed the interlocutory MPN treatment issue. Because the challenge was solely to an interlocutory finding, the Board applied the removal standard rather than reconsideration. Finding no significant prejudice or irreparable harm and no due process violation (since the MPN issue was framed and confirmed by defense counsel at trial without objection), the Board denied the petition.

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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