What the panel ordered
WCJ decision affirmed; Petition for Reconsideration denied
Petition for Reconsideration filed by applicant and granted for further study; WCJ report adopted and incorporated; decision after reconsideration issued affirming WCJ findings
What was disputed, and how it came out
Each issue the panel decided, with the reasoning it gave. An outcome is what this panel did on this record — not a rule, and not a prediction.
Applicant failed to demonstrate any attempt to contact the medical access assistant or any deficiency in the MPN; the WCJ's findings that the applicant must treat within the MPN were affirmed.
From the decision · page 41. Applicant has not demonstrated that he has made any direct attempts to contact the Medical Access Assistant
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Applicant did not make any direct attempts to contact the medical access assistant despite having the required access information for two years.
Favours Defendant prevailed
This failure meant applicant did not meet the statutory requirement to treat outside the MPN, leading to denial of his request and affirmance of the WCJ decision.
From the decision · page 4Applicant made no attempt to contact the medical access assistant. He has not demonstrated that there is any deficiency in their compliance with the statute and regulation. For two years he has had the required access information and he has not shown any attempt to use it.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Labor Code section 4616; 8 Cal.Code.Regs 9767.5
Labor Code section 4616 and 8 Cal.Code.Regs 9767.5 require a medical access assistant to be available and accessible to injured workers within an MPN.
Applicant must demonstrate noncompliance with the medical access assistant requirement to treat outside the MPN; failure to do so results in denial of such treatment.
From the decision · page 4The Labor Code requires that a MPN must be staffed with one or more persons available by tollfree phone within certain specified hours to respond to injured workers, contact physician's offices, and schedule appointments. (Labor Code section 4616(a)(5).) The promulgating regulations provide instructions on exactly how a defendant shall provide access, including specifications that medical access assistant's contacts be logged accurately and separately from that of the claims adjuster. (8 Cal.Code.Regs 9767.5(h)(2).)
What proof carried it
The evidence the panel weighed, by kind.
Applicant made no attempt to contact the medical access assistant despite having access information for two years
From the decision · page 4Applicant made no attempt to contact the medical access assistant. He has not demonstrated that there is any deficiency in their compliance with the statute and regulation. For two years he has had the required access information and he has not shown any attempt to use it.
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About this page
- A published decision of the California Workers' Compensation Appeals Board, taken apart by what it turned on. The Board publishes the decision itself; this page adds the extraction and quotes the passage behind every claim.
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