Count Of Fresno, permissibly self-insured, previously adjusted by Claims Management Services, Inc., now adjusted by York Insurance Services Group, Inc. Imelda Sanchez WORKERS’ COMPENSATION APPEALS BOARDSTATE OF CALIFORNIAIMELDA SANCHEZ, Applicant,vs.COUNTY OF FRESNO, permissibly self-insured, previously adjusted by CLAIMS MANAGEMENT SERVICES, INC., nowadjusted by YORK INSURANCE SERVICES GROUP, INC., Defendants.Case No. ADJ3425466 (FRE 0244904) OPINION AND DECISION AFTER RECONSIDERATION On February 10, 2012, we granted defendant’s Petition for Reconsideration of the November 17, 2011 Findings of Fact, Orders, and Award issued by the workers’ compensation administrative law judge (hereafter “WCJ”). Therein, the WCJ found that applicant sustained admitted industrial injury to her cervical spine, left shoulder, and left wrist; that she did not sustain industrial injury to her lumbar spine, bilateral knees, right ankle, or right hip;1 that defendant neglected to provide reasonable medical treatment by failing to provide required notices to applicant of her rights under its Medical Provider Network (MPN); that defendant is responsible for the adjustment and payment of applicant’s self-procured medical treatment received from lien claimant San Joaquin Accident and Medical Group (hereafter “San Joaquin”) from March 19, 2009 to June 21, 2010; that treatment for the cervical spine, left shoulder, left wrist, and lumbar spine between March 19, 2009 through September 23, 2009 was reasonable; and that treatment to the cervical spine only between September 23, 2009 and June 21, 2010 was reasonable. Based on these findings, the WCJ ordered 1 The findings that applicant sustained admitted industrial injury to her cervical spine, left shoulder, and left wrist and did not sustain industrial injury to her lumbar spine, bilateral knees, right ankle, or right hip were originally made by the WCJ in a September 23, 2009 Findings of Fact, Award, and Orders. , defendant to revi
Imelda Sanchez vs. Count Of Fresno: Adjustments by York Insurance
(FRE 0244904)The County of Fresno, permissibly self-insured, was previously adjusted by Claims Management Services, Inc. and is now adjusted by York Insurance Services Group, Inc. Imelda Sanchez filed a workers' compensation claim after sustaining an industrial injury to her cervical spine, left shoulder, and left wrist. The Workers' Compensation Appeals Board affirmed the November 17, 2011 Findings of Fact, Orders, and Award, finding that the County of Fresno neglected to provide reasonable medical treatment by failing to provide required notices to the applicant of her rights under its Medical Provider Network and is responsible for the adjustment and payment of the applicant's self-procured medical treatment.
- Filed On:
- Court: California, Fresno
- Case No. ADJ3425466
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