California: Lien Claim Fails When Applicant Not Entitled to Self-Procure Outside Medical Provider Network

California: Lien Claim Fails When Applicant Not Entitled to Self-Procure Outside Medical Provider Network

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Medical Provider Networks; Treatment Outside MPN.

WCAB, reversing WCJ, ordered that lien claimant take nothing by way of its lien for medical treatment self-procured by applicant outside defendant’s MPN, when WCAB found that letter sent by defendant notifying applicant that medical treatment would be provided through defendant’s MPN and advising applicant regarding how to access MPN provider, was prima facie evidence of delivery of required notice to applicant of his rights under MPN and prima facie evidence that defendant’s MPN was available to applicant for reasonable medical treatment of his industrial injury, and lien claimant failed to rebut defendant’s evidence that applicant was not entitled to self-procure medical treatment outside of its MPN. See Zuniga panel decision.

Reminder: Be sure to check the subsequent history of a case before citing to it.

© Copyright 2012 LexisNexis. All rights reserved. This case summary will appear in a forthcoming issue of the California WCAB Noteworthy Panel Decisions Reporter (LexisNexis).

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