CompFox AI Summary
This case involves an applicant seeking to treat outside his employer's approved medical provider network (MPN) for a shoulder and arm injury. The applicant argued the MPN lacked sufficient orthopedic specialists within 15 miles, but the Appeals Board found this was the wrong distance standard for specialists. Crucially, the Board determined the applicant failed to prove neglect, refusal, or denial of medical treatment, particularly since surgery was authorized and the reason for not undergoing it was unexplained. Therefore, reconsideration was granted, and the applicant's request to treat outside the MPN was denied.
Full Decision Text1 Pages
This case involves an applicant seeking to treat outside his employer's approved medical provider network (MPN) for a shoulder and arm injury. The applicant argued the MPN lacked sufficient orthopedic specialists within 15 miles, but the Appeals Board found this was the wrong distance standard for specialists. Crucially, the Board determined the applicant failed to prove neglect, refusal, or denial of medical treatment, particularly since surgery was authorized and the reason for not undergoing it was unexplained. Therefore, reconsideration was granted, and the applicant's request to treat outside the MPN was denied.
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