CompFox AI Summary
This case concerns whether an injured worker, Teresa Villagran, can seek medical treatment outside of her employer's Medical Provider Network (MPN) at the employer's expense. The Appeals Board rescinded a prior decision, finding that the applicant is not eligible to treat outside the MPN because the employer had a valid MPN and had authorized treatment. While the employer failed to schedule an appointment as stipulated, this failure did not justify self-procuring treatment outside the network, especially after the applicant agreed to seek treatment within the MPN. A dissenting opinion argued for further development of the record to explore the employer's failure to honor the stipulation.
Full Decision Text1 Pages
This case concerns whether an injured worker, Teresa Villagran, can seek medical treatment outside of her employer's Medical Provider Network (MPN) at the employer's expense. The Appeals Board rescinded a prior decision, finding that the applicant is not eligible to treat outside the MPN because the employer had a valid MPN and had authorized treatment. While the employer failed to schedule an appointment as stipulated, this failure did not justify self-procuring treatment outside the network, especially after the applicant agreed to seek treatment within the MPN. A dissenting opinion argued for further development of the record to explore the employer's failure to honor the stipulation.
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