Carolee Peterson vs. Ralph's Grocery: Exploring Self-Insured Options

(VNO 0550515) is a case in which Carolee Peterson, an employee of Ralph's Grocery Company, was injured while on the job. The Workers' Compensation Appeals Board found that the employer had failed to comply with the statutory and regulatory notices necessary to require the injured worker to treat within a medical provider network. The Board also found that the employee was entitled to be treated by her primary treating physician, even though he was not a member of the employer's medical provider network. The Board affirmed the Findings and Award of the Workers' Compensation Administrative Law Judge.

RALPH’S GROCERY COMPANY, Permissibly Self-Insured, CAROLEE PETERSON, WORKERS’ COMPENSATION APPEALS BOARDSTATE OF CALIFORNIACAROLEE PETERSON, Applicant,vs.RALPH’S GROCERY COMPANY, Permissibly Self-Insured, Defendants,Case No. ADJ284264 (VNO 0550515)OPINION AND DECISION AFTER RECONSIDERATION            On March 2, 2009, we granted defendant’s petition for reconsideration in order to allow sufficient opportunity to further study the factual and legal issues in this case. This is our decision after reconsideration.            Applicant, while employed as a manager/customer service/ stocker from September 2006 through April 6, 2007, sustained an industrial injury to her right shoulder and right upper extremity and claims to have sustained injury to sleep, psyche and internal. On December 8, 2008, the workers’ compensation administrative law judge (WCJ) issued a Findings and Award, finding that applicant was entitled to be treated by her primary treating physician, even though he is not a member of the employer’s medical provider network (MPN) (see Labor Code section 46161) and that she was temporarily totally disabled from April 7, 2007, to the present and continuing.            Defendant contends that it has complied with the notice requirements in Knight v. United Parcel Service (2006) 71 Cal.Comp.Cases 1423 (appeals board en banc) and Labor Code section 4610 tsic];2 that the award of temporary disability indemnity from April 7, 2007, through October 31, 2007, is not supported by substantial evidence; and that the WCJ failed to specifically establish how defendant failed to meet its burden. Applicant has filed an answer. 1Unless otherwise specified, all statutory references are to the Labor Code.2The notice requirements for MPNs are set forth at section 4616.3 and Administrative Director Rule 9767.12(a) (CaX Code Regs., tit. 8, § 9767.12(a)). ,             Upon further review of the entire record, and for the reasons set forth by the WCJ in his Report of Workers’ Compe

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