WCPanelIQ
En BancQMEMed-legalGranted in Part

Yne Valdez

YNE VALDEZ, Applicant vs. WAREHOUSE DEMO SERVICES; ZURICH NORTH AMERICA, Adjusted By ESIS, Defendants

ADJ number
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Decision date
Date unavailable
District office
—
WCJ
—
Claim administrator
ESIS (adjusting for Zurich North America)
Commissioners
—

Injury / body parts: back, right hip, neck

LC §115LC §4060LC §4061LC §4061.5LC §4062LC §4062.2LC §4062.3LC §4063LC §4063LC §4600LC §4600.5LC §4605LC §4610LC §4616LC §4616.3LC §4616.4LC §4616.6LC §4616.7LC §4650LC §4660LC §4663LC §4664LC §5307.1LC §5307.11LC §5307.27LC §5310LC §5703LC §5900LC §5903LC §5905CCR §35CCR §9767.1CCR §9767.6CCR §9785CCR §10341CCR §10507

Summary

In this en banc decision after reconsideration, the WCAB affirmed its April 20, 2011 holding that where an injured worker obtains unauthorized treatment outside a validly established and properly noticed MPN, the resulting non-MPN treatment reports are inadmissible and may not be relied upon to award benefits, including temporary disability indemnity. Applicant Elayne Valdez initially treated within the employer's MPN with Dr. Nagamoto but, on her attorney's referral, began treating with non-MPN physician Dr. Nario, whose reports the WCJ relied on to award temporary disability. The Board reasoned that the non-MPN physician cannot be the primary treating physician (PTP) since the MPN treater remains the PTP, and only the PTP renders opinions on medical issues necessary to determine eligibility for compensation. The Board grounded its holding not solely on Labor Code section 4616.6 but on the broader MPN statutory scheme, AD Rule 9785, and the Rushing decision. The Board affirmed its decision and remanded for determination of whether the MPN was validly established and properly noticed. The Board separately dismissed the petition of Armando Saldivar, an applicant in a different case, finding him not aggrieved under section 5900(a) in the present matter.

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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