Home/Case Law/Dennis Pasquel vs. The Boeing Company, ACE American Insurance Company, Sedgwick Claims Management Services, Inc.
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Dennis Pasquel vs. The Boeing Company, ACE American Insurance Company, Sedgwick Claims Management Services, Inc.

Filed: Feb 05, 2015
Anaheim
ADJ4189084 (AHM 0150210), ADJ2609035 (MON 0237343), ADJ2256301 (MON 0237524), ADJ4536480 (MON 0315454)

CompFox AI Summary

The Workers' Compensation Appeals Board overturned a judge's decision and allowed a lien for medical treatment provided by Dr. Powers at Griffin Medical Group. The Board found that while Dr. Powers was listed in the employer's Medical Provider Network (MPN) at a specific facility, there was no explicit restriction in the MPN listing prohibiting him from treating patients elsewhere. The Board concluded that contract disputes between a physician and an MPN provider should not prevent payment for medically necessary treatment when the MPN itself acknowledged the physician as a provider. This decision allows Griffin Medical Group to be paid for Dr. Powers' services rendered at their facility.

Full Decision Text1 Pages

The Workers' Compensation Appeals Board overturned a judge's decision and allowed a lien for medical treatment provided by Dr. Powers at Griffin Medical Group. The Board found that while Dr. Powers was listed in the employer's Medical Provider Network (MPN) at a specific facility, there was no explicit restriction in the MPN listing prohibiting him from treating patients elsewhere. The Board concluded that contract disputes between a physician and an MPN provider should not prevent payment for medically necessary treatment when the MPN itself acknowledged the physician as a provider. This decision allows Griffin Medical Group to be paid for Dr. Powers' services rendered at their facility.

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