WAL-MART ASSOCIATES, INC; AMERICAN HOME INSURANCE, GUADALUPE DELA MORA, WORKERS’ COMPENSATION APPEALS BOARDSTATE OF CALIFORNIAGUADALUPE DELA MORA, Applicant,vs.WAL-MART ASSOCIATES, INC;AMERICAN HOME INSURANCE, Defendant.Case No. ADJ4490816 (VNO 0511659)OPINION AND DECISION AFTER RECONSIDERATION On October 28, 2008, 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. On December 12, 2004, applicant sustained an industrial injury to her right shoulder and right elbow and claims to have sustained injury to her psyche, spine, head, right hip, right lower extremity and right major hand. On May 10, 2005, defendant received approval of its medical provider network (MPN). Defendant claims to have sent a Transfer of Care letter to applicant on September 22, 2005, together with the MPN Policy (in English and Spanish), Transfer of Care Plan Employee Copy (in English and Spanish), and Continuity of Care Plan Employee Copy (in English and Spanish). Applicant, who is monolingual in Spanish, testified that she did not receive these documents. At trial there was expert testimony that the Spanish documents allegedly sent to applicant were unintelligible. On January 9, 2006, Dr. Simon Lavi, who is not a member of defendant’s MPN, requested authorization to perform right shoulder surgery. Defendant’s qualified medical evaluator (QME) confirmed the need for right shoulder surgery. However, defendant did not authorize the surgery. Instead, it requested a hearing on the issue of transferring applicant’s care to the MPN. After two days of trial, the workers’ compensation administrative law judge (WCJ) issued a Findings of Fact and Award dated August 8, 2008. He found, in relevant part, that applicant is , suffering from a serious chronic condition that requires ongoing treatment to prevent deterioration; that a
