Home/Case Law/JOSE RAMIREZ vs. LUCKY FARMS, INSURANCE COMPANY OF THE WEST
Regular DecisionReconsideration

JOSE RAMIREZ vs. LUCKY FARMS, INSURANCE COMPANY OF THE WEST

Filed: Sep 20, 2018
San Bernardino
ADJ8326077

CompFox AI Summary

The Workers' Compensation Appeals Board granted reconsideration of a WCJ's order finding the defendant failed to prove a valid Medical Provider Network (MPN) and proper notice to the applicant. The Board rescinded the WCJ's decision and returned the case for further proceedings. The central issue is whether the defendant provided proper MPN notice and, if not, whether this failure resulted in a denial of medical care, justifying treatment outside the MPN. The Board emphasized that the defendant has the burden to prove proper notice, and lien claimants must then prove denial of care if notice was deficient.

Full Decision Text1 Pages

The Workers' Compensation Appeals Board granted reconsideration of a WCJ's order finding the defendant failed to prove a valid Medical Provider Network (MPN) and proper notice to the applicant. The Board rescinded the WCJ's decision and returned the case for further proceedings. The central issue is whether the defendant provided proper MPN notice and, if not, whether this failure resulted in a denial of medical care, justifying treatment outside the MPN. The Board emphasized that the defendant has the burden to prove proper notice, and lien claimants must then prove denial of care if notice was deficient.

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JOSE RAMIREZ vs. LUCKY FARMS, INSURANCE COMPANY OF THE WEST (2018) – San Bernardino | CompFox