ADJ7991744 · April 14, 2025

Defendant unreasonably denied medical treatment and issued defective transfer of care notices, so applicant is entitled to treat outside the MPN and penalties and attorney fees were properly awarded.

Defendant's transfer of care notices were statutorily defective.

Favours Applicant prevailed

This defect made defendant's denial of treatment unreasonable, allowing applicant to treat outside MPN.

From the decision · page 6We agree with the WCJ's analysis that defendant's transfer of care notices were statutorily defective. Accordingly, defendant's denial of treatment while this dispute was pending was not reasonable and applicant is permitted to continue treat outside the MPN with her presently selected primary treater. That is because defendant unreasonably denied medical treatment pursuant to section 4600. In the future, and to avoid duplication of such disputes, defendant may wish to seek judicial resolution of a dispute prior to terminating treatment. When a defendant unilaterally terminates provision of medical treatment, it does so at its own peril.

Defendant unreasonably delayed medical treatment by denying authorization for over one year based on applicant treating outside MPN.

Favours Applicant prevailed

Unreasonable delay justified penalties and attorney fees awarded to applicant.

From the decision · page 4The decision further determined that defendant's Transfer of Care Notices to the applicant were uniformly defective, and that the defendant had unreasonably delayed medical treatment to the applicant when it denied authorization for more than one year on the grounds that applicant was treating outside its network. Finally, attorney fees were awarded, after adjustments described in the Opinion, but generally based on applicant's Counsel's Bills of Particulars which were billed in quarter-hour increments.

Labor Code section 4600; Braewood Convalescent Hosp. v. Workers' Comp. Appeals Bd. (1983) 34 Cal. 3d 159

Employer must provide reasonable medical treatment to cure or relieve effects of industrial injury and cannot unreasonably deny treatment.

Defendant's denial of treatment was unreasonable, permitting applicant to treat outside MPN despite transfer notices.

From the decision · page 5Defendant's liability for medical treatment arises under section 4600, which requires defendant to provide reasonable medical treatment to cure or relieve the effects of an industrial injury. Reasonable and necessary medical treatment shall be provided by the employer. (§ 4600(a).) "In the case of his or her neglect or refusal reasonably to do so, the employer is liable for the reasonable expense incurred by or on behalf of the employee in providing treatment." (Ibid.) The Supreme Court has discussed the consequences of an employer's refusal to provide medical treatment:

Labor Code section 4603.2(a)(2)

If employer objects to employee's physician selection outside MPN and there is a final determination of entitlement, employee may continue treatment with that physician at employer's expense.

Applicant entitled to continue treatment outside MPN due to prior final determination and defendant's defective transfer notices.

From the decision · page 5Section 4603.2(a)(2) reads, in pertinent part:

Defendant's transfer of care notices were uniformly defective and denial of treatment was unreasonable.

From the decision · page 4The decision further determined that defendant's Transfer of Care Notices to the applicant were uniformly defective, and that the defendant had unreasonably delayed medical treatment to the applicant when it denied authorization for more than one year on the grounds that applicant was treating outside its network. Finally, attorney fees were awarded, after adjustments described in the Opinion, but generally based on applicant's Counsel's Bills of Particulars which were billed in quarter-hour increments.