WCPanelIQ
PanelDenied

Jose Quintana — ADJ12495318

JOSE QUINTANA, Applicant vs. BMC; LM INSURANCE COMPANY, Defendants

ADJ number
ADJ12495318
Decision date
Sep 16, 2021
District office
Sacramento
WCJ
Michael Geller
Claim administrator
LM Insurance Company
Commissioners
—

Injury / body parts: low back, neck, right shoulder

LC §4616CCR §9767.5

Summary

Applicant Jose Quintana, a framer who sustained an accepted low back injury on May 13, 2019, sought to treat outside defendant's Medical Provider Network (MPN), arguing the medical access assistant (MAA) requirement had not been met. The WCJ found, and the Board affirmed on reconsideration, that applicant never directly contacted the MAA despite receiving the required contact information three times over two years. The Board held that applicant cannot delegate his responsibility to contact the MAA by instructing the claims administrator or defense attorney to do so, and that he failed to demonstrate any deficiency in the MPN. The Board adopted and incorporated the WCJ's report and affirmed the May 5, 2021 Findings of Fact, requiring applicant to treat within the MPN.

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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