ADJ19947925 — California WCAB decision

What the panel ordered

Petition for Reconsideration granted; final decision after reconsideration deferred pending further review of merits

Petition for Reconsideration granted and final decision deferred pending further review

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 / IMRApplicant prevailedright eye

Applicant contends entitlement to change PTP or seek second opinion within MPN; original PTP and PQME found MMI with no further treatment needed; reconsideration granted to further study legal and factual issues.

From the decision · page 1Applicant seeks reconsideration of the March 12, 2025 Findings and Award (F&A) wherein the workers' compensation administrative law judge (WCJ) found, in relevant part, that applicant is not entitled to a new primary treating physician (PTP) as both the original PTP, Robert Innocenzi, D.O, in a report dated October 15, 2015, and panel qualified medical evaluator (PQME), Armin Visteh, M.D., in a report dated July 20, 2023, found that the applicant had reached maximum medical improvement (MMI) with no need for future medical care.

The facts that decided it

What the panel did with the medical opinions

The role the physician served, and the weight the opinion carried. Physicians are named here as the decision names them; we do not score them.

PTPRelied upon · ophthalmology

Discharged applicant from care on October 15, 2015, with no permanent disability or need for future medical treatment.

From the decision · page 3II. We provide the relevant facts of the case below: Applicant claimed that, while employed by defendant as a dishwasher on August 10, 2015, he sustained an industrial injury to his right eye. Applicant designated ophthalmologist, Dr. Robert A. Innocenzi Jr., as his PTP. In a report dated October 15, 2015, Dr. Innocenzi discharged applicant from care, without permanent disability or need for future medical treatment. (Exhibit A, p. 2.) Thereafter, the parties proceeded with discovery and retained Dr. Armin Vishteh as the ophthalmology PQME. Dr. Vishteh evaluated the applicant, and in a corresponding report dated July 20, 2023, Dr. Vishteh indicated that no further ophthalmic care was needed for applicant's injury of August 10, 2015 to the right eye. (Joint Exhibit 1, p. 5.) On January 8, 2025, applicant filed a Declaration of Readiness to Proceed to an Expedited Hearing requesting authorization for treatment by a new PTP, Dr. Wayne Martin, from defendant's MPN. On March 4, 2025, an expedited hearing was held on the issues of need for further medical treatment; whether applicant has a right to a second opinion; whether applicant is barred from any

QMERelied upon · ophthalmology

Evaluated applicant and found no further ophthalmic care needed in report dated July 20, 2023.

From the decision · page 3II. We provide the relevant facts of the case below: Applicant claimed that, while employed by defendant as a dishwasher on August 10, 2015, he sustained an industrial injury to his right eye. Applicant designated ophthalmologist, Dr. Robert A. Innocenzi Jr., as his PTP. In a report dated October 15, 2015, Dr. Innocenzi discharged applicant from care, without permanent disability or need for future medical treatment. (Exhibit A, p. 2.) Thereafter, the parties proceeded with discovery and retained Dr. Armin Vishteh as the ophthalmology PQME. Dr. Vishteh evaluated the applicant, and in a corresponding report dated July 20, 2023, Dr. Vishteh indicated that no further ophthalmic care was needed for applicant's injury of August 10, 2015 to the right eye. (Joint Exhibit 1, p. 5.) On January 8, 2025, applicant filed a Declaration of Readiness to Proceed to an Expedited Hearing requesting authorization for treatment by a new PTP, Dr. Wayne Martin, from defendant's MPN. On March 4, 2025, an expedited hearing was held on the issues of need for further medical treatment; whether applicant has a right to a second opinion; whether applicant is barred from any

The rules the panel named

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

Labor Code section 4600

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

Employer must provide reasonable medical treatment; MPN limits treatment to physicians within network.

From the decision · page 4III. We highlight the following legal principles that may be relevant to our review of this matter: Section 4600 requires the employer to provide reasonable medical treatment to cure or relieve from the effects of an industrial injury. (Lab. Code, § 4600(a).) If an employer has established an MPN, injured workers are generally limited to treatment with a physician from within that MPN. (Lab. Code, § 4600(c), 4616 et seq.) Pursuant to WCAB Rule 9767.6(e), at any point in time after the initial medical evaluation with the MPN physician, "the covered employee may select a physician of his or her choice from within the MPN." (Cal. Code Regs., tit. 8, § 9767.6(e).) Further, pursuant to WCAB Rule 9767.7(a), "[i]f the covered employee disputes either the diagnosis or the treatment prescribed by the primary treating physician or the treating physician, the employee may obtain a second and third opinion from physicians within the MPN." (Cal. Code Regs., tit.

WCAB Rule 9767.6(e)

WCAB Rule 9767.6(e) allows employee to select a physician within MPN after initial evaluation.

Employee may select physician within MPN after initial evaluation.

From the decision · page 4III. We highlight the following legal principles that may be relevant to our review of this matter: Section 4600 requires the employer to provide reasonable medical treatment to cure or relieve from the effects of an industrial injury. (Lab. Code, § 4600(a).) If an employer has established an MPN, injured workers are generally limited to treatment with a physician from within that MPN. (Lab. Code, § 4600(c), 4616 et seq.) Pursuant to WCAB Rule 9767.6(e), at any point in time after the initial medical evaluation with the MPN physician, "the covered employee may select a physician of his or her choice from within the MPN." (Cal. Code Regs., tit. 8, § 9767.6(e).) Further, pursuant to WCAB Rule 9767.7(a), "[i]f the covered employee disputes either the diagnosis or the treatment prescribed by the primary treating physician or the treating physician, the employee may obtain a second and third opinion from physicians within the MPN." (Cal. Code Regs., tit.

WCAB Rule 9767.7(a)

WCAB Rule 9767.7(a) allows second and third opinions within MPN if employee disputes diagnosis or treatment by PTP.

Employee may obtain second and third opinions within MPN if dispute exists.

From the decision · page 4III. We highlight the following legal principles that may be relevant to our review of this matter: Section 4600 requires the employer to provide reasonable medical treatment to cure or relieve from the effects of an industrial injury. (Lab. Code, § 4600(a).) If an employer has established an MPN, injured workers are generally limited to treatment with a physician from within that MPN. (Lab. Code, § 4600(c), 4616 et seq.) Pursuant to WCAB Rule 9767.6(e), at any point in time after the initial medical evaluation with the MPN physician, "the covered employee may select a physician of his or her choice from within the MPN." (Cal. Code Regs., tit. 8, § 9767.6(e).) Further, pursuant to WCAB Rule 9767.7(a), "[i]f the covered employee disputes either the diagnosis or the treatment prescribed by the primary treating physician or the treating physician, the employee may obtain a second and third opinion from physicians within the MPN." (Cal. Code Regs., tit.

Labor Code sections 4616.3, 4616.4

Labor Code sections 4616.3 and 4616.4 allow seeking second and third opinions and independent medical review within MPN.

Employee may seek second and third opinions and IMR within MPN if dispute exists.

From the decision · page 4III. We highlight the following legal principles that may be relevant to our review of this matter: Section 4600 requires the employer to provide reasonable medical treatment to cure or relieve from the effects of an industrial injury. (Lab. Code, § 4600(a).) If an employer has established an MPN, injured workers are generally limited to treatment with a physician from within that MPN. (Lab. Code, § 4600(c), 4616 et seq.) Pursuant to WCAB Rule 9767.6(e), at any point in time after the initial medical evaluation with the MPN physician, "the covered employee may select a physician of his or her choice from within the MPN." (Cal. Code Regs., tit. 8, § 9767.6(e).) Further, pursuant to WCAB Rule 9767.7(a), "[i]f the covered employee disputes either the diagnosis or the treatment prescribed by the primary treating physician or the treating physician, the employee may obtain a second and third opinion from physicians within the MPN." (Cal. Code Regs., tit.

Labor Code section 9785(b)

Labor Code section 9785(b) governs designation of new PTP when continuing or future medical treatment is needed.

New PTP designation requires determination of need for continuing or future medical treatment.

From the decision · page 5Pursuant to section 9785(b): (b)(2) An employee may designate a new primary treating physician of his or her choice pursuant to Labor Code § 4600 or 4600.3 provided the primary treating physician has determined that there is a need for:

Tenet/Centinela Hospital Medical Center v. Workers' Comp. Appeals Bd. (Rushing) (2000) 80 Cal.App.4th 1041

Rushing (2000) 80 Cal.App.4th 1041 holds that if PTP finds applicant permanent and stationary with no future treatment, change of PTP requires compliance with QME process.

Applicant must comply with QME process to change PTP if original PTP found no future treatment needed.

From the decision · page 5(Lab. Code, § 9785(b)(2)-(3).) In Rushing, the Court of Appeal held that in cases wherein the PTP has found the applicant permanent and stationary and releases the applicant to return to work without the need for future medical treatment, the applicant is considered discharged and must comply with sections 9785(b), 4061, and 4062 for a change in the PTP. (Rushing, supra, at p. 1043.) Sections 4061 and 4062 pertain to the QME panel process. Pursuant to section 4061(b), "[i]f either the employee or employer objects to a medical determination made by the treating physician concerning the existence or extent of permanent impairment and limitations or the need for future medical care, and the employee is represented by an attorney, a medical evaluation to determine permanent disability shall be obtained as provided in Section 4062.2." (Lab. Code, § 4061(b).)

ADJ19947925 · May 19, 2025

What the panel ordered

What was disputed, and how it came out

The facts that decided it

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What the panel did with the medical opinions

The rules the panel named

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