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Roberta Aguilar — ADJ12729922

ROBERTA AGUILAR, Applicant vs. ALHAMBRA HOSPITAL; THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA, Defendants

ADJ number: ADJ12729922
Decision date: Sep 16, 2021
District office: Pomona
WCJ: —
Claim administrator: Sedgwick (administering for The Insurance Company of the State of Pennsylvania)
Commissioners: DEIDRA E. LOWE, COMMISSIONER, KATHERINE A. ZALEWSKI, CHAIR, AMBER INGELS, DEPUTY COMMISSIONER

Injury / body parts: bilateral wrists, bilateral elbows, bilateral hands, psyche, sleep, weight gain, hypertension, sexual dysfunction

LC §4600LC §4616LC §4616.3LC §4062LC §5402LC §5705CCR §9767.9CCR §9767.12

Summary

Applicant Roberta Aguilar claimed cumulative trauma injury while working as a collection specialist at Alhambra Hospital. Defendant initially denied the claim in November 2019, then accepted it for the bilateral wrists and elbows in August 2020 after a QME found a compensable cumulative trauma injury. Applicant treated with a non-MPN PTP, Dr. Khalid Ahmed, and defendant sought to transfer her into its MPN via attorney letters in 2021. The WCJ found applicant could continue treating outside the MPN at defendant's expense, and the Appeals Board denied reconsideration, holding that defendant failed to follow the required transfer-of-care process under AD Rule 9767.9 and failed to provide a complete MPN notice under Rule 9767.12.

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.

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.

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.

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.