ADJ19137360 — California WCAB decision

What the panel ordered

Petition for Reconsideration denied.

Petition for Reconsideration filed by lien claimant Physical Rehab Services was denied by the WCAB panel after review of the WCJ's Report and Opinion on Decision dated 12/17/2025.

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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.

Medical treatment / UR / IMRDefendant prevailedback · spine · spinal cord · lower extremities · knee

The court found that Defendant timely offered treatment within their MPN, Applicant was advised of their rights and responsibilities to treat within the MPN, and lien claimant failed to prove any denial of care that would entitle Applicant to treat outside the MPN. Therefore, lien claimant is not entitled to reimbursement for the self-procured treatment.

From the decision · page 12No, Applicant may not ignore Defendant's MPN and obtain evaluation and treatment from a non-MPN provider once Applicant has been advised of their rights and responsibilities to treat within Defendant's MPN, as indicated below. Once Applicant has been advised of their rights and responsibilities to treat within Defendant's MPN, lien claimant, standing in Applicant's shoes, has the burden to prove that there was some kind of denial of care that would entitle Applicant to treat outside of that MPN pursuant to the Knight decision (Knight v. UPS (2006) 71 Cal. Comp. Cases 1423 (en banc)) and pursuant to Labor Code § 4616.3(b). As indicated below, there was no showing of any denial of care by Defendant to Applicant. The services of lien claimant, Physical Rehab Services, would be considered self-procured treatment and Defendant is not responsible for reimbursement for those services.

The facts that decided it

What the panel treated as outcome-determinative, and which side it favoured.

Defendant timely offered treatment within their MPN and provided notices to Applicant and Applicant's counsel about MPN rights and responsibilities.

Favours Defendant prevailed

This established that Defendant maintained MPN control and complied with legal requirements, negating lien claimant's claim of denial of care.

Applicant's attorney acknowledged Defendant's MPN and selected Dr. Walter Burnham from the MPN list for treatment, which Defendant authorized.

Favours Defendant prevailed

This showed Applicant's awareness and acceptance of MPN treatment options, undermining lien claimant's argument for self-procured treatment reimbursement.

From the decision · page 8In the present case, there is no concern that Applicant clearly understands that care is available and how to obtain, as Applicant's attorney's letter dated 5/17/2024 (Defendant's Exhibit I) acknowledges both Defendant's MPN, the doctor's contained therein, and requests treatment

Lien claimant was notified on 4/30/2024 that Defendant would not pay for treatment outside the MPN and proceeded with treatment anyway.

Favours Defendant prevailed

This demonstrated lien claimant's knowledge of MPN control and refusal to comply, supporting denial of reimbursement.

From the decision · page 9What's more, lien claimant was also put on notice that "defendant will not assume payment for the cost of care outside the MPN" per Wei. The employer advised the provider on 4/30/2024 by way of letter and fax (Lien Claimant's Exhibit 3) that Defendant had a valid MPN established for Applicant in this case and Defendant would not pay for any treatment for this provider. This is part of lien claimant's own exhibits and was over a month before lien claimant's initial treatment for Applicant. Lien claimant was on notice, and had actual knowledge, of Defendant's MPN control but lien claimant chose to ignore it. The is specifically in violation of the holding in Wei, as indicated above.

The rules the panel named

Authorities as the decision cited them, with how this panel applied each one.

Labor Code 4600

Labor Code 4600 requires employer to provide reasonable medical treatment to cure or relieve effects of industrial injury.

Employer timely offered treatment within MPN; no denial of care found.

Labor Code 4616

Labor Code 4616 limits employer liability to treatment within MPN unless denial of care occurs.

Applicant was advised of MPN rights and responsibilities; no denial of care established.

From the decision · page 12No, Applicant may not ignore Defendant's MPN and obtain evaluation and treatment from a non-MPN provider once Applicant has been advised of their rights and responsibilities to treat within Defendant's MPN, as indicated below. Once Applicant has been advised of their rights and responsibilities to treat within Defendant's MPN, lien claimant, standing in Applicant's shoes, has the burden to prove that there was some kind of denial of care that would entitle Applicant to treat outside of that MPN pursuant to the Knight decision (Knight v. UPS (2006) 71 Cal. Comp. Cases 1423 (en banc)) and pursuant to Labor Code § 4616.3(b). As indicated below, there was no showing of any denial of care by Defendant to Applicant. The services of lien claimant, Physical Rehab Services, would be considered self-procured treatment and Defendant is not responsible for reimbursement for those services.

Knight v. United Parcel Service (2006) 71 Cal.Comp.Cases 1423 (en banc)

Knight v. United Parcel Service (2006) 71 Cal.Comp.Cases 1423 (en banc) establishes that denial of care entitles treatment outside MPN.

Lien claimant failed to prove denial of care to justify treatment outside MPN.

From the decision · page 12No, Applicant may not ignore Defendant's MPN and obtain evaluation and treatment from a non-MPN provider once Applicant has been advised of their rights and responsibilities to treat within Defendant's MPN, as indicated below. Once Applicant has been advised of their rights and responsibilities to treat within Defendant's MPN, lien claimant, standing in Applicant's shoes, has the burden to prove that there was some kind of denial of care that would entitle Applicant to treat outside of that MPN pursuant to the Knight decision (Knight v. UPS (2006) 71 Cal. Comp. Cases 1423 (en banc)) and pursuant to Labor Code § 4616.3(b). As indicated below, there was no showing of any denial of care by Defendant to Applicant. The services of lien claimant, Physical Rehab Services, would be considered self-procured treatment and Defendant is not responsible for reimbursement for those services.

ADJ19137360 · March 23, 2026

What the panel ordered

What was disputed, and how it came out

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The facts that decided it

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